{"hospital_name": "Baptist Womens Health Center LLC", "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, "discou