{"hospital_name": "Surgical Institute of Reading LLC", "last_updated_on": "2026-04-08", "version": "3.0.0", "pid": "1549987627", "rid": "11846", "location_name": ["Surgical Institute of Reading"], "hospital_address": ["2752 Century Blvd, Wyomissing, PA 19610"], "type_2_npi": ["1124193511"], "license_information": {"license_number": "15301501", "state": "PA"}, "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": ".BLD# COMPL AUTO HHRWP&AUTO", "code_information": [{"code": "311111", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "setting": "both", "billing_class": "facility"}]}, {"description": ".URINALYSIS AUTOMATED", "code_information": [{"code": "81003", "type": "CPT"}, {"code": "381003", 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{"description": "ASSAY OF INSULIN", "code_information": [{"code": "83527", "type": "CPT"}], "standard_charges": [{"minimum": 11.66, "maximum": 17.9, "discounted_cash": 19.43, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 17.9, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ASSAY OF INTRINSIC FACTOR", "code_information": [{"code": "83528", "type": "CPT"}], "standard_charges": [{"minimum": 17.84, "maximum": 21.98, "discounted_cash": 29.73, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 21.98, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 17.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": 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"type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BARTONELLA HENSELEA DNA, TISSUE, PCR", "code_information": [{"code": "87801", "type": "CPT"}, {"code": "387801", "type": "CDM"}, {"code": "306", "type": "RC"}], "standard_charges": [{"minimum": 38.8, "maximum": 18252.0, "gross_charge": 390.0, "discounted_cash": 105.3, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 323.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 144.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 18252.0, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 102.49, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 234.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 265.2, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 98.78, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 273.0, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 38.8, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 63.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASE 4 MM GLENOID SHOULDER SYSTEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90003458", "type": "CDM"}, {"code": "278", "type": 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASE 4 MM GLENOID SM SHOULDER SYSTEM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90007115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 399.6, "maximum": 50544.0, "gross_charge": 1080.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 896.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 734.4, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 399.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 50544.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 648.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 734.4, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 756.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASE PLT TM REVERSE SHLD 15MM POS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90004107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1998.0, "maximum": 252720.0, "gross_charge": 5400.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 4482.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 3672.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1998.0, "methodology": "fee 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{"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 3488.4, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1898.1, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 240084.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 3078.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 3488.4, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 3591.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE MOD GLENIOD SYSTEM 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "90011688", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1648.35, "maximum": 208494.0, "gross_charge": 4455.0, "estimated_discounted_cash": 1283.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3697.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 3029.4, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1648.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 208494.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 3029.4, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE MOD GLENIOD SYSTEM 24MM +2LAT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "90011587", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1526.25, "maximum": 193050.0, "gross_charge": 4125.0, "estimated_discounted_cash": 1283.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3423.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2805.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1526.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 193050.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2475.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2805.0, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2887.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE MOD GLENIOD SYSTEM 24MM +4", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "90014083", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1648.35, "maximum": 208494.0, "gross_charge": 4455.0, "estimated_discounted_cash": 1283.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3697.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 3029.4, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1648.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 208494.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2673.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 3029.4, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 3118.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASEPLATE TIBIAL SZ 2 R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90011517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 999.0, "maximum": 126360.0, "gross_charge": 2700.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2241.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature 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"estimated_discounted_cash": 75.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 68.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 55.76, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 30.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 3837.6, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 12.36, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 49.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 55.76, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 11.91, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 57.4, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 9.36, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BASIC METAB PANEL ISTAT", "code_information": [{"code": "80048", "type": "CPT"}, {"code": "3800482", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.61, "maximum": 2433.6, "gross_charge": 52.0, "discounted_cash": 12.69, "estimated_discounted_cash": 75.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 43.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 19.24, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 2433.6, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 12.36, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 31.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 35.36, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 11.91, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 9.36, "methodology": "fee 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{"description": "BATTERY FOR HEARING DEVICE", "code_information": [{"code": "V5266", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.25, "maximum": 1.25, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 1.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BATTERY INSPIRE", "code_information": [{"code": "C1767", "type": "HCPCS"}, {"code": "2502809", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 19980.0, "maximum": 2527200.0, "gross_charge": 54000.0, "estimated_discounted_cash": 49208.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 44820.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 36720.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 19980.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 2527200.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 32400.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 36720.0, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 37800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BAYER ASPIRIN 325MG 1X200", "code_information": [{"code": "3002710", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BB ABO TYPE", "code_information": [{"code": "86891", "type": "CPT"}, {"code": "386891", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 209.05, 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Commercial", "standard_charge_dollar": 749.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 94770.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1215.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1377.0, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1417.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE SCREW 2.0X5MM", "code_information": [{"code": "90013803", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 203.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR CT/MRI IMAG", "code_information": [{"code": "55T", "type": "CPT"}], "standard_charges": [{"minimum": 388.36, "maximum": 1492.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 388.36, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE SRGRY CMPTR FLUOR IMAGE", "code_information": [{"code": "54T", "type": "CPT"}], "standard_charges": [{"minimum": 290.45, "maximum": 1492.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 290.45, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE TAP", "code_information": [{"code": "90009366", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 432.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE TAP 6.7MM", "code_information": [{"code": "90012210", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1070.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE VOID CEMENT QUICKSET 16CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90008130", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2989.6, "maximum": 378144.0, "gross_charge": 8080.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 6706.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 5494.4, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 2989.6, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 378144.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 4848.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 5494.4, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 5656.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID CEMENT QUICKSET 5CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90006538", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1538.46, "maximum": 194594.4, "gross_charge": 4158.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3451.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2827.44, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1538.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 194594.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2494.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2827.44, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2910.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID CEMENT QUICKSET 8CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90006371", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1993.19, "maximum": 252111.6, "gross_charge": 5387.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 4471.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 3663.16, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1993.19, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 252111.6, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 3232.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 3663.16, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 3770.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER 10CC SRS-010-RMS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90001536", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2937.06, "maximum": 371498.4, "gross_charge": 7938.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 6588.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 5397.84, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 2937.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 371498.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 4762.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 5397.84, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 5556.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER 10ML CERAMENT", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90006222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2692.49, "maximum": 340563.6, "gross_charge": 7277.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 6039.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 4948.36, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 2692.49, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 340563.6, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 4366.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 4948.36, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 5093.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER 5CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90007697", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1542.9, "maximum": 195156.0, "gross_charge": 4170.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3461.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2835.6, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1542.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 195156.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2502.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2835.6, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2919.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER 5ML CERAMENT", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90012913", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1393.79, "maximum": 176295.6, "gross_charge": 3767.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3126.61, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2561.56, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1393.79, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 176295.6, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2260.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2561.56, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2636.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER DRILLABLE 3CC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "90004855", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 882.82, "maximum": 111664.8, "gross_charge": 2386.0, "estimated_discounted_cash": 1283.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1980.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1622.48, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 882.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 111664.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1431.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1622.48, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1670.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE VOID FILLER INJECT KIT PRODENSE 4CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90010507", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1715.32, "maximum": 216964.8, "gross_charge": 4636.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3847.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 3152.48, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1715.32, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 216964.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2781.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 3152.48, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 3245.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 12394.0, "maximum": 12394.0, "discounted_cash": 10468.22, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12394.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT ILIAC CREST", "code_information": [{"code": "20970", "type": "CPT"}], "standard_charges": [{"minimum": 11700.0, "maximum": 11700.0, "discounted_cash": 10468.22, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT METATARSAL", "code_information": [{"code": "20972", "type": "CPT"}], "standard_charges": [{"minimum": 12394.0, "maximum": 12394.0, "discounted_cash": 10468.22, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12394.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT MICROVASC", "code_information": [{"code": "20969", "type": "CPT"}], "standard_charges": [{"minimum": 11700.0, "maximum": 11700.0, "discounted_cash": 10468.22, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "BONESYNC BIOACTIVE MATRIX STRIP 10CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2503111", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1480.0, "maximum": 187200.0, "gross_charge": 4000.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3320.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2720.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1480.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 187200.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2400.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2720.0, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2800.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONESYNC BIOACTIVE MATRIX STRIP 10CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "90014499", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1598.4, "maximum": 202176.0, "gross_charge": 4320.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3585.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2937.6, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1598.4, 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"National Advantage", "standard_charge_dollar": 2694.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2207.28, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1201.02, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2978.77, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 151912.8, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 3181.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1947.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2207.28, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4468.16, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 2978.77, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 134.96, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2272.2, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2978.77, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATION SALIVARY DUCT", "code_information": [{"code": "42650", "type": "CPT"}, {"code": "642650", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 35.0, "maximum": 11278.8, "gross_charge": 241.0, "discounted_cash": 2238.41, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 1453.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 200.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 163.88, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 89.17, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1453.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 11278.8, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 1712.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 144.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 163.88, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2179.58, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 1453.05, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 81.66, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 168.7, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 35.0, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1453.05, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2728.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DILATOR BALLOON FIXED WIRE 10-11-12 MM", "code_information": [{"code": "2501118", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 628.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BALLOON FIXED WIRE 6-7-8 MM", "code_information": [{"code": "2501116", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 628.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BALLOON FIXED WIRE 8-9-10 MM", "code_information": [{"code": "2501117", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 661.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BALLOON WIREGUIDE 15-16.5-18 MM", "code_information": [{"code": "2501138", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 724.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR BALLOON WIREGUIDE 18-19-20 MM", "code_information": [{"code": "2501139", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 724.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATOR THREADED 5.5MM", "code_information": [{"code": "90010015", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 790.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM 5MG/ML 10X10ML", "code_information": [{"code": "3002764", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM(CARDIZEM) 100MG/15ML ADD VL", "code_information": [{"code": "3010003", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM(CARDIZEM) 125MG/25ML", "code_information": [{"code": "3000067", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 19.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM(CARDIZEM) 30MG TAB", "code_information": [{"code": "3000066", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DILTIAZEM(CARDIZEM) 5MG/ML 5ML VL", "code_information": [{"code": "3000068", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIMECAPROL INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0470", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.81, "maximum": 59.81, "discounted_cash": 86.13, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 59.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIMETHADIONE", "code_information": [{"code": "82654", "type": "CPT"}, {"code": "382654", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 77.7, "maximum": 9828.0, "gross_charge": 210.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 174.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 77.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 9828.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIMETHYL SULFOXIDE 50% 50 ML", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1212", "type": "HCPCS"}], "standard_charges": [{"minimum": 680.82, "maximum": 680.82, "discounted_cash": 1057.43, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 680.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE ELIX 12.5MG/5ML 10ML SDC", "code_information": [{"code": "3000070", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHENHYDRAMINE(BENADRYL 50MG/1ML", "code_information": [{"code": "3000069", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DIPHTHERIA ANTITOXIN", "code_information": [{"code": "90296", "type": "CPT"}], "standard_charges": [{"minimum": 10.0, "maximum": 10.0, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 10.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPROPYLACETIC ACID", "code_information": [{"code": "80164", "type": "CPT"}, {"code": "380164", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 12.19, "maximum": 7300.8, "gross_charge": 156.0, "discounted_cash": 20.31, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 129.48, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 106.08, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 57.72, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 7300.8, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 19.78, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 93.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 106.08, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 19.06, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 109.2, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 18.72, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIPROPYLACETIC ACID FREE", "code_information": [{"code": "80165", "type": "CPT"}], "standard_charges": [{"minimum": 12.19, "maximum": 14.75, "discounted_cash": 20.31, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 14.75, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT REFER HOSPITAL OBSERV", "code_information": [{"code": "G0379", "type": "HCPCS"}], "standard_charges": [{"minimum": 611.99, "maximum": 917.99, "discounted_cash": 859.14, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 611.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 611.99, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 917.99, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 611.99, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 611.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIRECT REPAIR OF ANEURYSM", "code_information": [{"code": "35045", "type": "CPT"}, {"code": "635045", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1047.98, "maximum": 839638.8, "gross_charge": 17941.0, "discounted_cash": 8027.63, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 5235.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 14891.03, "methodology": "fee 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schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 5235.92, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 1047.98, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 12558.7, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5235.92, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12394.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION SHOULDER", "code_information": [{"code": "23920", "type": "CPT"}], "standard_charges": [{"minimum": 12394.0, "maximum": 12394.0, "discounted_cash": 18521.79, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12394.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DISARTICULATION THROUGH WRIST; SECONDARY", "code_information": [{"code": "25922", "type": "CPT"}, {"code": "625922", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 501.41, "maximum": 424148.4, "gross_charge": 9063.0, "discounted_cash": 2319.78, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 1531.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 7522.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 6162.84, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 3353.31, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1531.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 424148.4, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 3181.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 5437.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 6162.84, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2297.0, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 1531.33, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 501.41, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 6344.1, "methodology": 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"plan_name": "All Plans", "standard_charge_dollar": 1836.45, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2081.31, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2142.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HNDFT NAIL THRED 7.2X95", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "90025837", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1131.83, "maximum": 143161.2, "gross_charge": 3059.0, "estimated_discounted_cash": 1283.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2538.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2080.12, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1131.83, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 143161.2, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1835.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2080.12, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2141.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOFFMANN3 POST STRAIGHT DIA 11MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "90014773", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 370.74, "maximum": 46893.6, "gross_charge": 1002.0, "estimated_discounted_cash": 1404.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 831.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 681.36, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 370.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 46893.6, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 601.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 681.36, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 701.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOLE ELIMINATOR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90003116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 225.33, "maximum": 28501.2, "gross_charge": 609.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 505.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 414.12, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 225.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 28501.2, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 365.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 414.12, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 426.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME BASE STATION", "code_information": [{"code": "90013222", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1357.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HOME ENVIRONMENT ASSESSMENT", "code_information": [{"code": "T1028", "type": "HCPCS"}], "standard_charges": [{"minimum": 75.0, "maximum": 75.0, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 75.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOMOCSTEINE", "code_information": [{"code": "83090", "type": "CPT"}, {"code": "383090", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 16.13, "maximum": 5522.4, "gross_charge": 118.0, "discounted_cash": 26.88, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 97.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 80.24, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 43.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 5522.4, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 24.63, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 70.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 80.24, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 23.74, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 82.6, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 18.65, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 16.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOMOGENIZATION TISS CUL", "code_information": [{"code": "87176", "type": "CPT"}, {"code": "387176", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.29, "maximum": 4305.6, "gross_charge": 92.0, "discounted_cash": 8.82, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 76.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 62.56, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 34.04, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 4305.6, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 8.59, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 55.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 62.56, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 8.28, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 64.4, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 7.25, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOMOVANILLIC ACID", "code_information": [{"code": "83150", "type": "CPT"}, {"code": "383150", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.5, "maximum": 9828.0, "gross_charge": 210.0, "discounted_cash": 33.62, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 174.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 77.7, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 9828.0, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 16.99, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 126.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 142.8, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 147.0, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 7.5, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 20.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOOK LUNATE FACET 19MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "90012021", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 402.93, "maximum": 50965.2, "gross_charge": 1089.0, "estimated_discounted_cash": 1283.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 903.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 740.52, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 402.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 50965.2, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 653.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 740.52, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 762.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOOK LUNATE FACET 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "90012032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 503.57, "maximum": 63694.8, "gross_charge": 1361.0, "estimated_discounted_cash": 1283.87, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1129.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 925.48, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 503.57, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 63694.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 816.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 925.48, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 952.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOSPITAL OBSERVATION PER HR", "code_information": [{"code": "G0378", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.84, "maximum": 976.54, "estimated_discounted_cash": 734.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 14.84, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 976.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOT SHEARS MONOPOLAR CURVED SCISSORS", "code_information": [{"code": "90013807", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HPA-1 GENOTYPING", "code_information": [{"code": "81105", "type": "CPT"}], "standard_charges": [{"minimum": 110.0, "maximum": 120.71, "discounted_cash": 183.33, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 120.71, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 110.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-15 GENOTYPING", "code_information": [{"code": "81112", "type": "CPT"}], "standard_charges": [{"minimum": 110.0, "maximum": 110.0, "discounted_cash": 183.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 110.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-2 GENOTYPING", "code_information": [{"code": "81106", "type": "CPT"}], "standard_charges": [{"minimum": 110.0, "maximum": 110.0, "discounted_cash": 183.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 110.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-3 GENOTYPING", "code_information": [{"code": "81107", "type": "CPT"}], "standard_charges": [{"minimum": 110.0, "maximum": 110.0, "discounted_cash": 183.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 110.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-4 GENOTYPING", "code_information": [{"code": "81108", "type": "CPT"}], "standard_charges": [{"minimum": 110.0, "maximum": 110.0, "discounted_cash": 183.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 110.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-5 GENOTYPING", "code_information": [{"code": "81109", "type": "CPT"}], "standard_charges": [{"minimum": 110.0, "maximum": 110.0, "discounted_cash": 183.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 110.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-6 GENOTYPING", "code_information": [{"code": "81110", "type": "CPT"}], "standard_charges": [{"minimum": 110.0, "maximum": 110.0, "discounted_cash": 183.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 110.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPA-9 GENOTYPING", "code_information": [{"code": "81111", "type": "CPT"}], "standard_charges": [{"minimum": 110.0, "maximum": 110.0, "discounted_cash": 183.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 110.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV COMBO ASSAY CA SCREEN", "code_information": [{"code": "G0476", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.58, "maximum": 38.21, "discounted_cash": 52.64, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 38.21, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV HI RISK TYPES MALE URINE", "code_information": [{"code": "96U", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 31.58, "discounted_cash": 52.64, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV HI RSK QUAL MRNA E6/E7", "code_information": [{"code": "354U", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 31.58, "discounted_cash": 52.64, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV HIGH-RISK TYPES", "code_information": [{"code": "87624", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 38.21, "discounted_cash": 52.64, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 38.21, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV LOW-RISK TYPES", "code_information": [{"code": "87623", "type": "CPT"}], "standard_charges": [{"minimum": 31.58, "maximum": 38.21, "discounted_cash": 52.64, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 38.21, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HPV TYPES 16 & 18 ONLY", 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ANIFROLUMAB-FNIA 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0491", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.18, "maximum": 17.18, "discounted_cash": 25.53, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 17.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ APOTEX/BENDAMUSTINE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9058", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.78, "maximum": 20.78, "discounted_cash": 29.93, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 20.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ARIPIPRAZOLE EXT REL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0401", "type": "HCPCS"}], 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"standard_charges": [{"minimum": 1.23, "maximum": 1.23, "discounted_cash": 1.77, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CEFTOLOZANE TAZOBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0695", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.37, "maximum": 7.37, "discounted_cash": 12.81, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CLADRIBINE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9065", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.77, "maximum": 15.77, "discounted_cash": 15.08, "setting": "outpatient", "payers_information": [{"payer_name": 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"type": "HCPCS"}], "standard_charges": [{"minimum": 3.76, "maximum": 3.76, "discounted_cash": 12.87, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 3.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOSPHAMD AUROMEDIC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.79, "maximum": 1.79, "discounted_cash": 0.89, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DAUNORUBICIN, CYTARABINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9153", "type": "HCPCS"}], "standard_charges": [{"minimum": 231.76, "maximum": 231.76, "discounted_cash": 361.62, "setting": "outpatient", 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"plan_name": "Commercial", "standard_charge_dollar": 0.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ESTROGEN CONJUGATE 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1410", "type": "HCPCS"}], "standard_charges": [{"minimum": 372.15, "maximum": 372.15, "discounted_cash": 553.62, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 372.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FENSOLVI 0.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1951", "type": "HCPCS"}], "standard_charges": [{"minimum": 131.82, "maximum": 131.82, "discounted_cash": 199.1, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 131.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC CARBOXYMALTOS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1439", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.15, "maximum": 1.15, "discounted_cash": 1.56, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FILGRASTIM EXCL BIOSIMIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1442", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.99, "maximum": 0.99, "discounted_cash": 1.41, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 0.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FORAMEN EPIDURAL C/T", "code_information": [{"code": "64479", "type": "CPT"}, {"code": "664479", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 107.77, "maximum": 89481.6, "gross_charge": 1912.0, "discounted_cash": 1275.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 868.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1586.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1300.16, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 707.44, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 868.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 89481.6, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 1712.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1147.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1300.16, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1302.68, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 868.45, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 258.79, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1338.4, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 107.77, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 868.45, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FORAMEN EPIDURAL L/S", "code_information": [{"code": "64483", "type": "CPT"}, {"code": "664483", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 95.04, "maximum": 99169.2, "gross_charge": 2119.0, "discounted_cash": 1275.99, "estimated_discounted_cash": 2278.32, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 868.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1758.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1440.92, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 784.03, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 868.45, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 99169.2, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 1712.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1271.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1440.92, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 1302.68, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 868.45, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 233.35, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1483.3, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 95.04, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 868.45, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FOSNETUPITANT, PALONOSET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1454", "type": "HCPCS"}], "standard_charges": [{"minimum": 694.18, "maximum": 694.18, "discounted_cash": 812.64, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 694.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GEMCITABINE HCL (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9196", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.78, "maximum": 8.78, "discounted_cash": 12.63, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 8.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GIVOSIRAN 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0223", "type": "HCPCS"}], "standard_charges": [{"minimum": 112.08, "maximum": 112.08, "discounted_cash": 165.72, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 112.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GLOFITAMAB GXBM, 2.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9286", "type": "HCPCS"}], "standard_charges": [{"minimum": 2707.93, "maximum": 2707.93, "discounted_cash": 3908.45, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2707.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GLUCAGON HCL, FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1611", "type": "HCPCS"}], "standard_charges": [{"minimum": 123.83, "maximum": 123.83, "discounted_cash": 210.39, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 123.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN, PFIZER, 1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1643", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.58, "maximum": 4.58, "discounted_cash": 6.6, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 4.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HERZUMA 10 MG", "code_information": [{"code": "Q5113", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.31, "maximum": 40.31, "discounted_cash": 97.95, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 40.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HUMAN FIBRINOGEN CON NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7178", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.38, "maximum": 1.38, "discounted_cash": 2.15, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HYDROXYPROGST CAPOAT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1729", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.18, "maximum": 18.18, "discounted_cash": 26.18, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 18.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IMIP 4 CILAS 4 RELEB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0742", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.46, "maximum": 2.46, "discounted_cash": 3.54, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ INOTUZUMAB OZOGAM 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9229", "type": "HCPCS"}], "standard_charges": [{"minimum": 2580.15, "maximum": 2580.15, "discounted_cash": 3809.84, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2580.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IRINOTECAN LIPOSOME 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9205", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.02, "maximum": 62.02, "discounted_cash": 93.2, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 62.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IRON DEXTRAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1750", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.32, "maximum": 17.32, "discounted_cash": 25.58, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 17.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IVIG PRIVIGEN 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1459", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.29, "maximum": 48.29, "discounted_cash": 71.66, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 48.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LABETALOL HCL HIKMA, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1921", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.56, "maximum": 2.56, "discounted_cash": 3.68, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LEFAMULIN 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0691", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.72, "maximum": 0.72, "discounted_cash": 1.05, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 0.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LEVOLEUCOVORIN NOS 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0641", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 0.07, "discounted_cash": 0.11, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 0.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LON TESIRIN-LPYL 0.075MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9359", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.63, "maximum": 200.63, "discounted_cash": 306.29, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 200.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LUSPATERCEPT-AAMT 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0896", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.97, "maximum": 39.97, "discounted_cash": 59.28, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 39.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LUXTURNA 1 BILLION VEC G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3398", "type": "HCPCS"}], "standard_charges": [{"minimum": 2872.28, "maximum": 2872.28, "discounted_cash": 4239.86, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2872.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MELPHA HYDROCH NOS 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9245", "type": "HCPCS"}], "standard_charges": [{"minimum": 148.02, "maximum": 148.02, "discounted_cash": 135.42, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 148.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MIDAZOLAM (WG CRIT CARE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.28, "maximum": 0.28, "discounted_cash": 0.41, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 0.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MOGAMULIZUMAB-KPKC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9204", "type": "HCPCS"}], "standard_charges": [{"minimum": 234.17, "maximum": 234.17, "discounted_cash": 350.9, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 234.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MOSUNETUZUMAB-AXGB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9350", "type": "HCPCS"}], "standard_charges": [{"minimum": 629.64, "maximum": 629.64, "discounted_cash": 924.39, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 629.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MOXIFLOXACIN (FRES KABI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2281", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.81, "maximum": 5.81, "discounted_cash": 8.36, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MVASI 10 MG", "code_information": [{"code": "Q5107", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.62, "maximum": 25.62, "discounted_cash": 39.35, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 25.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ NIVOL RELATLIMAB 3MG/1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9298", "type": "HCPCS"}], "standard_charges": [{"minimum": 187.15, "maximum": 187.15, "discounted_cash": 279.35, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 187.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ OGIVRI 10 MG", "code_information": [{"code": "Q5114", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.43, "maximum": 44.43, "discounted_cash": 56.9, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 44.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ OLIPUDASE ALFA-RPCP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0218", "type": "HCPCS"}], "standard_charges": [{"minimum": 376.97, "maximum": 376.97, "discounted_cash": 555.87, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 376.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ONASE ABEPAR-XIOI TREAT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3399", "type": "HCPCS"}], "standard_charges": [{"minimum": 2302784.67, "maximum": 2302784.67, "discounted_cash": 3466788.05, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2302784.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ONTRUZANT 10 MG", "code_information": [{"code": "Q5112", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.94, "maximum": 38.94, "discounted_cash": 26.84, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 38.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERTEBRAL L/S ADD-ON DO NOT USE", "code_information": [{"code": "64476", "type": "CPT"}, {"code": "664476", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 784.03, "maximum": 99169.2, "gross_charge": 2119.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1758.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1440.92, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 784.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 99169.2, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1271.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1440.92, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1483.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PARAVERTEBRAL L/S DO NOT USE", "code_information": [{"code": "64475", "type": "CPT"}, {"code": "664475", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 707.44, "maximum": 89481.6, "gross_charge": 1912.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1586.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1300.16, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 707.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 89481.6, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1147.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1300.16, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1338.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRAST EX BIO 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2506", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.68, "maximum": 50.68, "discounted_cash": 126.15, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 50.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRASTIM-BMEZ 0.5MG", "code_information": [{"code": "Q5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 346.76, "maximum": 346.76, "discounted_cash": 42.81, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 346.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMBROLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.73, "maximum": 55.73, "discounted_cash": 85.14, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 55.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (ACCORD) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9296", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.66, "maximum": 9.66, "discounted_cash": 13.76, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 9.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (SANDOZ) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9297", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.3, "maximum": 1.3, "discounted_cash": 1.86, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.3, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (TEVA) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9314", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.96, "maximum": 19.96, "discounted_cash": 21.95, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 19.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED DITROMETHAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9323", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.01, "maximum": 6.01, "discounted_cash": 0.18, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 6.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED, HOSPIRA 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.55, "maximum": 10.55, "discounted_cash": 5.01, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 10.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PLASMINOGEN TVMH 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2998", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.8, "maximum": 31.8, "discounted_cash": 46.28, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 31.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PLATELET RICH PLASMA ANY SITE INCLUD", "code_information": [{"code": "232T", "type": "CPT"}, {"code": "602321", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 45.0, "maximum": 54896.4, "gross_charge": 1173.0, "discounted_cash": 644.48, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 973.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 797.64, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 434.01, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 54896.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 703.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 797.64, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 569.45, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 45.0, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 821.1, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 379.63, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PROCEDURE FOR DISKOGRAPHY EACH", "code_information": [{"code": "62291", "type": "CPT"}, {"code": "662291", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 80.0, "maximum": 89481.6, "gross_charge": 1912.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1586.96, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1300.16, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 707.44, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 89481.6, "methodology": "fee 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"outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT ESRD ON DIALYSI", "code_information": [{"code": "Q5105", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.78, "maximum": 0.78, "discounted_cash": 1.13, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 0.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT NON-ESRD USE", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.82, "maximum": 7.82, "discounted_cash": 11.09, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RISANKIZUMAB-RZAA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2327", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.36, "maximum": 15.36, "discounted_cash": 21.09, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 15.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RISPERDAL CONSTA, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2794", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.15, "maximum": 12.15, "discounted_cash": 15.51, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RITUXIMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9311", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.41, "maximum": 37.41, "discounted_cash": 51.81, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 37.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ROCTAVIAN ML 2X10^13VC G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1412", "type": "HCPCS"}], "standard_charges": [{"minimum": 12007.81, "maximum": 12007.81, "discounted_cash": 17726.72, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12007.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN LYOPHIL 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9319", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.96, "maximum": 31.96, "discounted_cash": 43.47, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 31.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN NON-LYO 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9318", "type": "HCPCS"}], "standard_charges": [{"minimum": 33.91, "maximum": 33.91, "discounted_cash": 40.28, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 33.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RONZANOLIXIZUM-NOLI 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9333", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.26, "maximum": 22.26, "discounted_cash": 32.72, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 22.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RUXIENCE, 10 MG", "code_information": [{"code": "Q5119", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.45, "maximum": 20.45, "discounted_cash": 39.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 20.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SEBELIPASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2840", "type": "HCPCS"}], "standard_charges": [{"minimum": 538.75, "maximum": 538.75, "discounted_cash": 762.39, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 538.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SECRETIN SYNTHETIC HUMAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2850", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.74, "maximum": 41.74, "discounted_cash": 57.21, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 41.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SIROLIMUS PROT PART 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9331", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.29, "maximum": 109.29, "discounted_cash": 119.42, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 109.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SODIUM THIOSULFATE 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0208", "type": "HCPCS"}], "standard_charges": [{"minimum": 96.19, "maximum": 96.19, "discounted_cash": 134.3, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 96.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TALIMOGENE LAHERPAREPVEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.59, "maximum": 66.59, "discounted_cash": 104.42, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 66.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TALQUETAMAB-TGVS 0.25 MG", "code_information": [{"code": "C9163", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.69, "maximum": 66.69, "discounted_cash": 96.05, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 66.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TBO FILGRASTIM 1 MICROG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1447", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.44, "maximum": 0.44, "discounted_cash": 0.39, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 0.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TECLISTAMAB CQYV 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9380", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.85, "maximum": 30.85, "discounted_cash": 47.42, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 30.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEDIZOLID PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3090", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.78, "maximum": 1.78, "discounted_cash": 2.78, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEPLIZUMAB MZWV 5 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9381", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.26, "maximum": 36.26, "discounted_cash": 53.18, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 36.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEZEPELUMAB-EKKO, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2356", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.59, "maximum": 18.59, "discounted_cash": 25.43, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 18.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TISOTU VEDOTIN-TFTV, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9273", "type": "HCPCS"}], "standard_charges": [{"minimum": 168.31, "maximum": 168.31, "discounted_cash": 266.54, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 168.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TOFERSEN INTRATHEC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1304", "type": "HCPCS"}], "standard_charges": [{"minimum": 150.84, "maximum": 150.84, "discounted_cash": 225.09, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 150.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRASTUZUMAB EXCL BIOSIMI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.47, "maximum": 80.47, "discounted_cash": 105.95, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 80.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRIAMCINOLONE ACE XR 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3304", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.54, "maximum": 17.54, "discounted_cash": 25.85, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 17.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRUXIMA 10 MG", "code_information": [{"code": "Q5115", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.89, "maximum": 35.89, "discounted_cash": 41.49, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 35.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ UBLITUXIMAB-XIIY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2329", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.66, "maximum": 67.66, "discounted_cash": 99.9, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 67.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ VASOPRESSIN (AM REG) 1 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2599", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.46, "maximum": 0.46, "discounted_cash": 0.66, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", 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"EA"}, "code_information": [{"code": "J0184", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.08, "maximum": 9.08, "discounted_cash": 13.58, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 9.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, AMIVANTAMAB-VMJW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9061", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.98, "maximum": 19.98, "discounted_cash": 31.83, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 19.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, APONVIE, 1 MG", "code_information": [{"code": "C9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.88, "maximum": 1.88, "discounted_cash": 2.7, "setting": "outpatient", "payers_information": 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"EA"}, "code_information": [{"code": "J9371", "type": "HCPCS"}], "standard_charges": [{"minimum": 3420.78, "maximum": 3420.78, "discounted_cash": 4926.44, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 3420.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VUTRISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0225", "type": "HCPCS"}], "standard_charges": [{"minimum": 4947.38, "maximum": 4947.38, "discounted_cash": 7065.5, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 4947.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ZIV-AFLIBERCEPT, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9400", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.28, "maximum": 7.28, "discounted_cash": 11.13, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. (ANI), UP TO 40 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0802", "type": "HCPCS"}], "standard_charges": [{"minimum": 3348.99, "maximum": 3348.99, "discounted_cash": 4991.1, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 3348.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. ACTHAR GEL TO 40 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0801", "type": "HCPCS"}], "standard_charges": [{"minimum": 4095.32, "maximum": 4095.32, "discounted_cash": 5838.38, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 4095.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. ASCENIV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1554", "type": "HCPCS"}], "standard_charges": [{"minimum": 491.41, "maximum": 491.41, "discounted_cash": 701.43, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 491.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. AVSOLA, 10 MG", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.56, "maximum": 25.56, "discounted_cash": 28.82, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 25.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. BELRAPZO/BENDAMUSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.09, "maximum": 13.09, "discounted_cash": 17.34, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 13.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. BYOOVIZ, 0.1 MG", "code_information": [{"code": "Q5124", "type": "HCPCS"}], "standard_charges": [{"minimum": 187.51, "maximum": 187.51, "discounted_cash": 87.27, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 187.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. CEFEPIME HCL (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0701", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.64, "maximum": 5.64, "discounted_cash": 8.12, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. CETIRIZINE HCL 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1201", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.07, "maximum": 15.07, "discounted_cash": 23.33, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 15.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. EPTINEZUMAB-JJMR 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3032", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.06, "maximum": 18.06, "discounted_cash": 28.2, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 18.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. FE DERISOMALTOSE 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1437", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.86, "maximum": 18.86, "discounted_cash": 31.1, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 18.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. HERCEPTIN HYLECTA, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9356", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.02, "maximum": 66.02, "discounted_cash": 86.76, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 66.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. INEBILIZUMAB-CDON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1823", "type": "HCPCS"}], "standard_charges": [{"minimum": 473.51, "maximum": 473.51, "discounted_cash": 699.75, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 473.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. INFUGEM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9198", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.28, "maximum": 40.28, "discounted_cash": 58.01, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 40.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. ISATUXIMAB-IRFC 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9227", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.5, "maximum": 76.5, "discounted_cash": 115.65, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 76.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. JIVI 1 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7208", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.34, "maximum": 2.34, "discounted_cash": 3.74, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. LUMASIRAN, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0224", "type": "HCPCS"}], "standard_charges": [{"minimum": 319.56, "maximum": 319.56, "discounted_cash": 464.64, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 319.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. LURBINECTEDIN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9223", "type": "HCPCS"}], "standard_charges": [{"minimum": 200.01, "maximum": 200.01, "discounted_cash": 292.49, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 200.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. MARGETUXIMAB-CMKB, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 47.05, "maximum": 47.05, "discounted_cash": 74.12, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 47.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. MYCOPHENOLATE MOFETIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.73, "maximum": 0.73, "discounted_cash": 1.05, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 0.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. NAXITAMAB-GQGK, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9348", "type": "HCPCS"}], "standard_charges": [{"minimum": 609.77, "maximum": 609.77, "discounted_cash": 968.69, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 609.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. OLANZAPINE, 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2359", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.95, "maximum": 0.95, "discounted_cash": 1.37, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 0.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED NOS 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.37, "maximum": 4.37, "discounted_cash": 6.15, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 4.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9304", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.32, "maximum": 62.32, "discounted_cash": 65.4, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 62.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. RIABNI, 10 MG", "code_information": [{"code": "Q5123", "type": "HCPCS"}], "standard_charges": [{"minimum": 41.42, "maximum": 41.42, "discounted_cash": 37.44, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 41.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. ROMOSOZUMAB-AQQG 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3111", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.73, "maximum": 10.73, "discounted_cash": 17.04, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 10.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. TAGRAXOFUSP-ERZS 10 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9269", "type": "HCPCS"}], "standard_charges": [{"minimum": 325.56, "maximum": 325.56, "discounted_cash": 504.02, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 325.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. TEPROTUMUMAB-TRBW 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3241", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.0, "maximum": 328.0, "discounted_cash": 507.2, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 328.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. TIGECYCLINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3244", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.65, "maximum": 2.65, "discounted_cash": 3.83, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. VILTOLARSEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1427", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.83, "maximum": 58.83, "discounted_cash": 84.72, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 58.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. XEMBIFY, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1558", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.18, "maximum": 14.18, "discounted_cash": 20.97, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 14.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., APREPITANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0185", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.73, "maximum": 1.73, "discounted_cash": 2.31, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., ARISTADA INITIO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1943", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.09, "maximum": 3.09, "discounted_cash": 4.59, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 3.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BENDEKA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.76, "maximum": 14.76, "discounted_cash": 19.05, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 14.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BENRALIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.5, "maximum": 169.5, "discounted_cash": 232.41, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 169.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BREXANOLONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1632", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.1, "maximum": 72.1, "discounted_cash": 103.83, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 72.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., CEMIPLIMAB-RWLC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9119", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.46, "maximum": 27.46, "discounted_cash": 41.36, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 27.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., COPANLISIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 87.56, "maximum": 87.56, "discounted_cash": 126.11, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 87.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., DURVALUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9173", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.71, "maximum": 80.71, "discounted_cash": 120.2, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 80.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., EMAPALUMAB-LZSG, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9210", "type": "HCPCS"}], "standard_charges": [{"minimum": 375.66, "maximum": 375.66, "discounted_cash": 543.44, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 375.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., EMICIZUMAB-KXWH 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7170", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.65, "maximum": 50.65, "discounted_cash": 79.22, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 50.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., ERAVACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.13, "maximum": 1.13, "discounted_cash": 1.83, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., EVOMELA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9246", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.49, "maximum": 16.49, "discounted_cash": 26.13, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 16.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., FIBRYGA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7177", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.1, "maximum": 1.1, "discounted_cash": 1.74, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., FREMANEZUMAB-VFRM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3031", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.84, "maximum": 1.84, "discounted_cash": 2.66, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., GUSELKUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1628", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.5, "maximum": 72.5, "discounted_cash": 107.28, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 72.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., IBALIZUMAB-UIYK, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1746", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.62, "maximum": 74.62, "discounted_cash": 111.92, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 74.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., ILUVIEN, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7313", "type": "HCPCS"}], "standard_charges": [{"minimum": 490.95, "maximum": 490.95, "discounted_cash": 703.41, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 490.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., KANJINTI, 10 MG", "code_information": [{"code": "Q5117", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.45, "maximum": 13.45, "discounted_cash": 67.14, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 13.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., LUMOXITI, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9313", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.39, "maximum": 23.39, "discounted_cash": 33.03, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 23.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., MEROPENEM, VABORBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2186", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.08, "maximum": 2.08, "discounted_cash": 3.08, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., OMADACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.66, "maximum": 3.66, "discounted_cash": 5.67, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 3.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., PATISIRAN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0222", "type": "HCPCS"}], "standard_charges": [{"minimum": 99.98, "maximum": 99.98, "discounted_cash": 141.17, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 99.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., PERSERIS, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2798", "type": "HCPCS"}], 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AQUEOUS DRAIN DEVICE", "code_information": [{"code": "253T", "type": "CPT"}], "standard_charges": [{"minimum": 11700.0, "maximum": 11700.0, "discounted_cash": 5963.1, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT BALLOON DEVICE", "code_information": [{"code": "33973", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/ IMAGE", "code_information": [{"code": "32557", "type": "CPT"}], "standard_charges": [{"minimum": 132.6, "maximum": 1890.0, "discounted_cash": 2270.96, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 132.6, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CATH PLEURA W/O IMAGE", "code_information": [{"code": "32556", "type": "CPT"}], "standard_charges": [{"minimum": 97.3, "maximum": 2728.0, "discounted_cash": 2768.33, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 97.3, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2728.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT CV CATH INF & SUP APP", "code_information": [{"code": "C9780", "type": "HCPCS"}], "standard_charges": [{"minimum": 14305.0, "maximum": 14305.0, "discounted_cash": 11650.29, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 14305.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT DRUG DEL IMPLANT, >=4", "code_information": [{"code": "G0516", "type": "HCPCS"}], "standard_charges": [{"minimum": 1492.0, "maximum": 1492.0, "discounted_cash": 644.48, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ENDOVASC PROSTH TAA", "code_information": [{"code": "33883", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD ENDO", "code_information": [{"code": "33203", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT EPICARD ELTRD OPEN", "code_information": [{"code": "33202", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT GROSHONG TUNNELED CENTRAL VAD", "code_information": [{"code": "36561", "type": "CPT"}, {"code": "636561", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1141.82, "maximum": 144424.8, "gross_charge": 3086.0, "discounted_cash": 4555.16, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2561.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2098.48, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1141.82, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 144424.8, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 4010.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1851.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2098.48, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4555.52, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 1156.12, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2160.2, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7929.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEPATIC SHUNT (TIPS)", "code_information": [{"code": "37182", "type": "CPT"}], "standard_charges": [{"minimum": 14305.0, "maximum": 14305.0, "discounted_cash": 26446.22, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 14305.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT HEYMAN UTERI CAPSULE", "code_information": [{"code": "58346", "type": "CPT"}], "standard_charges": [{"minimum": 198.02, "maximum": 5456.0, "discounted_cash": 7216.8, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 198.02, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT I-AORT PERCUT DEVICE", "code_information": [{"code": "33967", "type": "CPT"}], "standard_charges": [{"minimum": 10218.0, "maximum": 10218.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 10218.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT INTERBODY BIOMECH DEVICE W INTEGR", "code_information": [{"code": "22853", "type": "CPT"}, {"code": "622853", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 269.8, "maximum": 188978.4, "gross_charge": 4038.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3351.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2745.84, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1494.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 188978.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2422.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2745.84, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 269.8, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2826.6, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT INTERBODY BIOMECH DEVICE W INTEGR", "code_information": [{"code": "22854", "type": "CPT"}, {"code": "622854", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 349.25, "maximum": 188978.4, "gross_charge": 4038.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3351.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2745.84, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1494.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 188978.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2422.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2745.84, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 349.25, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2826.6, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT INTERBODY BIOMECH DEVICE W INTEGR", "code_information": [{"code": "22859", "type": "CPT"}, {"code": "622859", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 349.25, "maximum": 188978.4, "gross_charge": 4038.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 3351.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2745.84, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1494.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 188978.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2422.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2745.84, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 349.25, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2826.6, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT INTRACORPOREAL DEVICE", "code_information": [{"code": "33979", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT IOL W/ CATARACT EXT CURRENT", "code_information": [{"code": "66985", "type": "CPT"}, {"code": "666985", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 583.93, "maximum": 505767.6, "gross_charge": 10807.0, "discounted_cash": 3329.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 2220.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 8969.81, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 7348.76, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 3998.59, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2220.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 505767.6, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 4010.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 6484.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 7348.76, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 3330.53, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 2220.35, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 725.2, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 7564.9, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 583.93, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 2220.35, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33330", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MAJOR VESSEL GRAFT", "code_information": [{"code": "33335", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT MDM ID22.2MM 36C", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90013256", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3046.21, "maximum": 385304.4, "gross_charge": 8233.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 6833.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 5598.44, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 3046.21, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 385304.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 4939.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 5598.44, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 5763.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE BONE CAVITY", "code_information": [{"code": "36680", "type": "CPT"}], "standard_charges": [{"minimum": 49.5, "maximum": 1492.0, "discounted_cash": 644.48, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 49.5, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NEEDLE CATH BOWEL", "code_information": [{"code": "44015", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNELED CENTRALLY INSERT", "code_information": [{"code": "36556", "type": "CPT"}, {"code": "636556", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 113.21, "maximum": 25084.8, "gross_charge": 536.0, "discounted_cash": 4555.16, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 444.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 364.48, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 198.32, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 25084.8, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 2323.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 321.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 364.48, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4555.52, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 230.97, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 375.2, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 113.21, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT OR30 DM 28/42MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90011831", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 3541.64, "maximum": 447969.6, "gross_charge": 9572.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 7944.76, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 6508.96, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 3541.64, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 447969.6, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 5743.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 6508.96, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 6700.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 221.32, "maximum": 2728.0, "discounted_cash": 2238.41, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 1453.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1453.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2179.58, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 1453.05, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 221.32, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1453.05, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2728.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PELV FIXATION DEVICE", "code_information": [{"code": "22848", "type": "CPT"}], "standard_charges": [{"minimum": 1492.0, "maximum": 1492.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PERIPHERALLY CATH W/O SUBCUTA", "code_information": [{"code": "36569", "type": "CPT"}, {"code": "636569", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 87.39, "maximum": 25084.8, "gross_charge": 536.0, "discounted_cash": 2270.96, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 1525.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 444.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 364.48, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 198.32, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1525.93, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 25084.8, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 2323.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 321.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 364.48, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2288.9, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 1525.93, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 252.47, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 375.2, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 87.39, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1525.93, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}, {"code": "657160", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 15.15, "maximum": 7909.2, "gross_charge": 169.0, "discounted_cash": 291.66, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 189.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 140.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 114.92, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 62.53, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 189.86, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 7909.2, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 816.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 101.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 114.92, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 284.79, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 189.86, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 75.84, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 118.3, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 15.15, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 189.86, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PLEURAL CATH", "code_information": [{"code": "32550", "type": "CPT"}], "standard_charges": [{"minimum": 7929.0, "maximum": 7929.0, "discounted_cash": 5165.28, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7929.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PROST URETHRAL STENT", "code_information": [{"code": "53855", "type": "CPT"}], "standard_charges": [{"minimum": 1890.0, "maximum": 1890.0, "discounted_cash": 3015.71, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN MULT LEADS", "code_information": [{"code": "33221", "type": "CPT"}], "standard_charges": [{"minimum": 18392.0, "maximum": 18392.0, "discounted_cash": 27787.97, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 18392.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22841", "type": "CPT"}], "standard_charges": [{"minimum": 1492.0, "maximum": 1492.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22843", "type": "CPT"}], "standard_charges": [{"minimum": 1492.0, "maximum": 1492.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SPINE FIXATION DEVICE", "code_information": [{"code": "22844", "type": "CPT"}], "standard_charges": [{"minimum": 1492.0, "maximum": 1492.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SUBQ EXTEN TO IP CATH", "code_information": [{"code": "49435", "type": "CPT"}], "standard_charges": [{"minimum": 2728.0, "maximum": 2728.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2728.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT SZ 2 35 INSERT/22 HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90012750", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 664.52, "maximum": 84052.8, "gross_charge": 1796.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1490.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1221.28, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 664.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 84052.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1077.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1221.28, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1257.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SZ 3 40 INSERT/28 HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90011465", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 949.05, "maximum": 120042.0, "gross_charge": 2565.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2128.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1744.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 949.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 120042.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1539.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1744.2, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1795.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SZ 3 40 INSERT/28 HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90011493", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 664.52, "maximum": 84052.8, "gross_charge": 1796.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1490.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1221.28, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 664.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 84052.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1077.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1221.28, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1257.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SZ 4 42 INSERT/28 HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90011255", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 664.52, "maximum": 84052.8, "gross_charge": 1796.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1490.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1221.28, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 664.52, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 84052.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1077.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1221.28, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1257.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT SZ 5 45 INSERT/28 HEAD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90012551", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 949.05, "maximum": 120042.0, "gross_charge": 2565.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2128.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1744.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 949.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 120042.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1539.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1744.2, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1795.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SZ 2 X14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90011516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 699.3, "maximum": 88452.0, "gross_charge": 1890.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1568.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 88452.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1323.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SZ 3 X15MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90014080", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 699.3, "maximum": 88452.0, "gross_charge": 1890.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1568.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 88452.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1323.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TIBIAL SZ 5 X10MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90012714", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 699.3, "maximum": 88452.0, "gross_charge": 1890.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 1568.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 699.3, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 88452.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1134.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1285.2, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1323.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT TISSUE EXPANDER(S)", "code_information": [{"code": "11960", "type": "CPT"}, {"code": "611960", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 625.0, "maximum": 144097.2, "gross_charge": 3079.0, "discounted_cash": 5112.38, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 3418.26, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2555.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 2093.72, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1139.23, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3418.26, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 144097.2, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 3181.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1847.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 2093.72, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5127.39, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 3418.26, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 883.01, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 2155.3, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 625.0, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3418.26, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7929.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUN IP CATH PERC", "code_information": [{"code": "49418", "type": "CPT"}], "standard_charges": [{"minimum": 7929.0, "maximum": 7929.0, "discounted_cash": 5165.28, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7929.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT TUNNELED CENTRALLY INSERTED C", "code_information": [{"code": "36558", "type": "CPT"}, {"code": "636558", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 198.32, "maximum": 25084.8, "gross_charge": 536.0, "discounted_cash": 4555.16, "setting": "both", "payers_information": [{"payer_name": "AETNA", 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"Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, DNA, Spike Protein, Chimpanzee Adenovirus Oxford 1 (Chadox1) Vector, Preservative Free, 5x1010 Viral Particles/0.5ml Dosage; Second Dose", "code_information": [{"code": "22A", "type": "CPT"}], "standard_charges": [{"minimum": 40.0, "maximum": 40.0, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 100 Mcg/0.5ml Dosage; First Dose", "code_information": [{"code": "11A", "type": "CPT"}], "standard_charges": [{"minimum": 20.33, "maximum": 40.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute 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"methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 34.07, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3ml Dosage, Diluent Reconstituted; First Dose", "code_information": [{"code": "1A", "type": "CPT"}], "standard_charges": [{"minimum": 20.33, "maximum": 40.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 20.33, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3ml Dosage, Diluent Reconstituted; Second Dose", "code_information": [{"code": "2A", "type": "CPT"}], 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"plan_name": "Med Plus", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Recombinant Spike Protein Nanoparticle, Saponin-Based Adjuvant, Preservative Free, 5 Mcg/0.5ml Dosage; First Dose", "code_information": [{"code": "41A", "type": "CPT"}], "standard_charges": [{"minimum": 40.0, "maximum": 40.0, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Intramuscular Administration Of Single Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Recombinant Spike Protein Nanoparticle, Saponin-Based Adjuvant, Preservative Free, 5 Mcg/0.5ml Dosage; Second Dose", "code_information": [{"code": "42A", "type": "CPT"}], "standard_charges": [{"minimum": 40.0, 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[{"code": "27U", "type": "CPT"}], "standard_charges": [{"minimum": 109.72, "maximum": 109.72, "discounted_cash": 182.87, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 109.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAK2 GENE TRGT SEQUENCE ALYS", "code_information": [{"code": "81279", "type": "CPT"}], "standard_charges": [{"minimum": 148.16, "maximum": 166.68, "discounted_cash": 277.8, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 148.16, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JAW ARTHROSCOPY/SURGERY", "code_information": [{"code": "29800", "type": "CPT"}, {"code": "629800", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 512.93, "maximum": 382356.0, "gross_charge": 8170.0, "discounted_cash": 4720.37, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 6781.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 5555.6, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 3022.9, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 382356.0, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 4010.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 4902.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 5555.6, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4626.05, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 512.93, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 5719.0, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7929.0, "methodology": 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"77077", "type": "CPT"}], "standard_charges": [{"minimum": 23.32, "maximum": 108.97, "discounted_cash": 150.83, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 108.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JR GNOTYP ABCG2 EXONS 2-26", "code_information": [{"code": "193U", "type": "CPT"}], "standard_charges": [{"minimum": 254.59, "maximum": 254.59, "discounted_cash": 424.32, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JUNCTION BOX 5 DEG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90009709", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 246.05, "maximum": 31122.0, "gross_charge": 665.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 551.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 246.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 31122.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 399.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 452.2, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 465.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K CHLOR 20MEQ 100ML", "code_information": [{"code": "3000271", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 12.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE MULTIPLE", "code_information": [{"code": "78709", "type": "CPT"}], "standard_charges": [{"minimum": 185.64, "maximum": 489.4, "discounted_cash": 783.32, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 185.64, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 489.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/DRUG", "code_information": [{"code": "78708", "type": "CPT"}], "standard_charges": [{"minimum": 69.0, "maximum": 489.4, "discounted_cash": 783.32, "setting": "outpatient", "payers_information": 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PROCEDURES WITH MCC", "code_information": [{"code": "628", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30975.88, "maximum": 30975.88, "discounted_cash": 38449.23, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 30975.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "630", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10773.85, "maximum": 10773.85, "discounted_cash": 15057.6, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 10773.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [{"code": "319", "type": "MS-DRG"}], "standard_charges": [{"minimum": 33656.42, "maximum": 33656.42, "discounted_cash": 46043.54, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 33656.42, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [{"code": "320", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17175.82, "maximum": 17175.82, "discounted_cash": 24815.37, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 17175.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [{"code": "951", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4552.44, "maximum": 4552.44, "discounted_cash": 5736.23, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 4552.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC", "code_information": [{"code": "749", "type": "MS-DRG"}], "standard_charges": [{"minimum": 19422.72, "maximum": 19422.72, "discounted_cash": 26489.82, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 19422.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "750", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10493.76, "maximum": 10493.76, "discounted_cash": 15225.77, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 10493.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [{"code": "215", "type": "MS-DRG"}], "standard_charges": [{"minimum": 1533.0, "maximum": 1533.0, "discounted_cash": 102725.93, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1533.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [{"code": "424", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16105.61, "maximum": 16105.61, "discounted_cash": 22572.47, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 16105.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [{"code": "423", "type": "MS-DRG"}], "standard_charges": [{"minimum": 30176.5, "maximum": 30176.5, "discounted_cash": 42846.32, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 30176.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "425", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12360.26, "maximum": 12360.26, "discounted_cash": 15478.53, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12360.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [{"code": "868", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8375.72, "maximum": 8375.72, "discounted_cash": 10637.81, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 8375.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [{"code": "867", "type": "MS-DRG"}], "standard_charges": [{"minimum": 16144.19, "maximum": 16144.19, "discounted_cash": 21595.46, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 16144.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "869", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5329.44, "maximum": 5329.44, "discounted_cash": 7528.28, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5329.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [{"code": "922", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13463.65, "maximum": 13463.65, "discounted_cash": 18048.48, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 13463.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [{"code": "923", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7803.96, "maximum": 7803.96, "discounted_cash": 10499.57, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7803.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [{"code": "699", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7876.49, "maximum": 7876.49, "discounted_cash": 10471.71, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7876.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [{"code": "698", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12765.35, "maximum": 12765.35, "discounted_cash": 17068.37, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12765.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "700", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5465.24, "maximum": 5465.24, "discounted_cash": 7117.67, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5465.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [{"code": "674", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18381.06, "maximum": 18381.06, "discounted_cash": 24127.23, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 18381.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [{"code": "673", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28533.77, "maximum": 28533.77, "discounted_cash": 43347.72, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 28533.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "675", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12241.43, "maximum": 12241.43, "discounted_cash": 16934.25, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12241.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [{"code": "271", "type": "MS-DRG"}], "standard_charges": [{"minimum": 26668.04, "maximum": 26668.04, "discounted_cash": 36690.18, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 26668.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [{"code": "270", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39019.04, "maximum": 39019.04, "discounted_cash": 54435.35, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 39019.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "272", "type": "MS-DRG"}], "standard_charges": [{"minimum": 18823.18, "maximum": 18823.18, "discounted_cash": 26339.19, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 18823.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC", "code_information": [{"code": "729", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7746.09, "maximum": 7746.09, "discounted_cash": 10922.57, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7746.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "730", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4796.27, "maximum": 4796.27, "discounted_cash": 6933.0, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 4796.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC", "code_information": [{"code": "717", "type": "MS-DRG"}], "standard_charges": [{"minimum": 13994.51, "maximum": 13994.51, "discounted_cash": 19504.2, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 13994.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "718", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9072.47, "maximum": 9072.47, "discounted_cash": 13856.7, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 9072.47, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC", "code_information": [{"code": "715", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17033.07, "maximum": 17033.07, "discounted_cash": 23082.12, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 17033.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC", "code_information": [{"code": "716", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10973.7, "maximum": 10973.7, "discounted_cash": 15176.24, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 10973.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [{"code": "887", "type": "MS-DRG"}], "standard_charges": [{"minimum": 9996.85, "maximum": 9996.85, "discounted_cash": 11048.43, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 9996.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [{"code": "964", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11581.72, "maximum": 11581.72, "discounted_cash": 15811.77, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11581.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [{"code": "963", "type": "MS-DRG"}], "standard_charges": [{"minimum": 21097.86, "maximum": 21097.86, "discounted_cash": 28204.49, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 21097.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC", "code_information": [{"code": "965", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7375.72, "maximum": 7375.72, "discounted_cash": 9703.1, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7375.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [{"code": "565", "type": "MS-DRG"}], "standard_charges": [{"minimum": 7711.37, "maximum": 7711.37, "discounted_cash": 10052.84, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7711.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC", "code_information": [{"code": "564", "type": "MS-DRG"}], "standard_charges": [{"minimum": 12051.62, "maximum": 12051.62, "discounted_cash": 15925.25, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12051.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "566", "type": "MS-DRG"}], "standard_charges": [{"minimum": 5790.86, "maximum": 5790.86, "discounted_cash": 7730.49, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5790.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [{"code": "516", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15746.81, "maximum": 15746.81, "discounted_cash": 21439.67, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 15746.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC", "code_information": [{"code": "515", "type": "MS-DRG"}], "standard_charges": [{"minimum": 24394.13, "maximum": 24394.13, "discounted_cash": 32879.1, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 24394.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [{"code": "517", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11530.79, "maximum": 11530.79, "discounted_cash": 15854.07, "estimated_discounted_cash": 50279.9, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11530.79, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [{"code": "844", "type": "MS-DRG"}], "standard_charges": [{"minimum": 8928.96, "maximum": 8928.96, "discounted_cash": 12559.86, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 8928.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC", "code_information": [{"code": "843", "type": "MS-DRG"}], "standard_charges": [{"minimum": 14356.39, "maximum": 14356.39, "discounted_cash": 20580.26, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 14356.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC", "code_information": [{"code": "845", "type": "MS-DRG"}], "standard_charges": [{"minimum": 6673.57, "maximum": 6673.57, "discounted_cash": 8785.92, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 6673.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [{"code": "908", "type": "MS-DRG"}], "standard_charges": [{"minimum": 15463.64, "maximum": 15463.64, "discounted_cash": 20584.4, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 15463.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [{"code": "907", "type": "MS-DRG"}], "standard_charges": [{"minimum": 28699.66, "maximum": 28699.66, "discounted_cash": 39609.89, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 28699.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OTHER O.R. 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5378.0, "discounted_cash": 8540.27, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 4463.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 3657.04, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1989.86, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 251690.4, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 6177.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 3226.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 3657.04, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 8369.57, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 513.42, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 3764.6, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION, BILATERAL (WILKE", "code_information": [{"code": "42508", "type": "CPT"}, {"code": "642508", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 2238.5, "maximum": 283140.0, "gross_charge": 6050.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 5021.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 2238.5, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 283140.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 3630.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 4235.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION, BILATERAL (WILKE", "code_information": [{"code": "42509", "type": "CPT"}, {"code": "642509", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 825.42, "maximum": 283140.0, "gross_charge": 6050.0, "discounted_cash": 8540.27, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 5021.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 2238.5, "methodology": "fee 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"fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 4235.0, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PAROTID DUCT DIVERSION, BILATERAL (WILKE", "code_information": [{"code": "42510", "type": "CPT"}, {"code": "642510", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 631.04, "maximum": 283140.0, "gross_charge": 6050.0, "discounted_cash": 4783.07, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 3067.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 5021.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 2238.5, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3067.62, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 283140.0, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 6177.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 3630.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 4114.0, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4601.43, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 3067.62, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 631.04, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 4235.0, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3067.62, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART AGGLUJ SCR EA ANTB", "code_information": [{"code": "86403", "type": "CPT"}, {"code": "386403", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 10.39, "maximum": 3229.2, "gross_charge": 69.0, "discounted_cash": 17.31, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 57.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 25.53, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 3229.2, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 14.88, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 41.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 46.92, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 14.34, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 48.3, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 14.08, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 10.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART AGGLUJ TITER EA ANTB", "code_information": [{"code": "86406", "type": "CPT"}, {"code": "386406", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 9.58, "maximum": 4024.8, "gross_charge": 86.0, "discounted_cash": 15.96, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 71.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 58.48, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 31.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 4024.8, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 15.53, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 51.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 58.48, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 14.97, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 60.2, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 14.58, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 9.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PART EXC/CRATERIZATION BONE LESION", "code_information": [{"code": "23182", "type": "CPT"}, {"code": "623182", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 157.0, "maximum": 449139.6, "gross_charge": 9597.0, "discounted_cash": 10468.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 6816.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 7965.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 6525.96, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 3550.89, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6816.33, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 449139.6, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 4010.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 5758.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 6525.96, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 10224.5, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 6816.33, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 648.38, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 6717.9, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 157.0, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 6816.33, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7929.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL HIP BONE DEEP", "code_information": [{"code": "27071", "type": "CPT"}], "standard_charges": [{"minimum": 893.4, "maximum": 13073.0, "discounted_cash": 4720.37, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 13073.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 893.4, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 12394.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PART REMOVAL OF METATARSAL", "code_information": [{"code": "28110", "type": "CPT"}, {"code": "628110", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 266.46, "maximum": 250473.6, "gross_charge": 5352.0, "discounted_cash": 4720.37, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 4442.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 3639.36, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1980.24, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 250473.6, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 3181.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 3211.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 3639.36, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4626.05, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 429.2, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 3746.4, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 266.46, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PARTIAL EXC OF BONE OF ULNA", "code_information": [{"code": "25150", "type": "CPT"}, {"code": "625150", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 558.11, "maximum": 424148.4, "gross_charge": 9063.0, "discounted_cash": 4720.37, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 7522.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 6162.84, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 3353.31, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 424148.4, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 4010.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 5437.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 6162.84, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 4626.05, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 558.11, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 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"standard_charge_dollar": 77.52, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 14.53, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 79.8, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 14.27, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 9.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHORUS INORGANIC", "code_information": [{"code": "84100", "type": "CPT"}, {"code": "384100", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.27, "maximum": 2574.0, "gross_charge": 55.0, "discounted_cash": 7.11, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 45.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 2574.0, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 6.93, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 33.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 37.4, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 6.67, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 38.5, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 6.55, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 4.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOSPHORUS INORGANIC URINE", "code_information": [{"code": "84105", "type": "CPT"}, {"code": "384105", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 5.2, "maximum": 3042.0, "gross_charge": 65.0, "discounted_cash": 8.67, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 53.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 24.05, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 3042.0, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 7.56, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 39.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 44.2, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 7.28, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 45.5, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 7.15, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTO PATCH TEST", "code_information": [{"code": "95052", "type": "CPT"}], "standard_charges": [{"minimum": 5.81, "maximum": 5.81, "discounted_cash": 85.11, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 5.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHOTODYNAMIC TX ADDL 15 MIN", "code_information": [{"code": "96571", "type": "CPT"}], "standard_charges": [{"minimum": 1492.0, "maximum": 1492.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTODYNMC TX 30 MIN ADD-ON", "code_information": [{"code": "96570", "type": "CPT"}], "standard_charges": [{"minimum": 1492.0, "maximum": 1492.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOPHERESIS XTRCORP", "code_information": [{"code": "36522", "type": "CPT"}, {"code": "636522", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 923.15, "maximum": 116766.0, "gross_charge": 2495.0, "discounted_cash": 6283.49, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 4409.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2070.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1696.6, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 923.15, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4409.34, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 116766.0, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 4010.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1497.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1696.6, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 6614.01, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 4409.34, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 1311.32, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1746.5, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 4409.34, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 11700.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PHOTOSENSITIVITY TESTS", "code_information": [{"code": "95056", "type": "CPT"}], "standard_charges": [{"minimum": 1.55, "maximum": 1.55, "discounted_cash": 191.94, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 1.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV AUTHRJ", "code_information": [{"code": "86079", "type": "CPT"}], "standard_charges": [{"minimum": 41.56, "maximum": 44.78, "discounted_cash": 75.18, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 41.56, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV REACTJ", "code_information": [{"code": "86078", "type": "CPT"}], "standard_charges": [{"minimum": 41.56, "maximum": 244.11, "discounted_cash": 245.79, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 162.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.74, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 45.75, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 244.11, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 162.74, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 50.73, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 41.56, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 162.74, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYS BLOOD BANK SERV XMATCH", "code_information": [{"code": "86077", "type": "CPT"}], "standard_charges": [{"minimum": 22.2, "maximum": 41.83, "discounted_cash": 41.73, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 41.83, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 22.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL PRFRM TEST/MSR W/WRITTEN RPT EA", "code_information": [{"code": "97750", "type": "CPT"}, {"code": "5097750", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 30.73, "maximum": 16520.4, "gross_charge": 353.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 292.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 240.04, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 130.61, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 16520.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 211.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 240.04, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 247.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL PRFRM TEST/MSR W/WRITTEN RPT EA", "code_information": [{"code": "97750", "type": "CPT"}, {"code": "50977502", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 30.73, "maximum": 5382.0, "gross_charge": 115.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 95.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 78.2, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 42.55, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 5382.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 69.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 78.2, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 30.73, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 80.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL REHAB PROC NEC", "code_information": [{"code": "97799", "type": "CPT"}, {"code": "5097799", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 31.82, "maximum": 4024.8, "gross_charge": 86.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 71.38, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 58.48, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 31.82, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 4024.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 51.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 58.48, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 60.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL THERAPY EVAL", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "5097001", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"minimum": 63.61, "maximum": 22230.0, "gross_charge": 475.0, "estimated_discounted_cash": 436.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 394.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 175.75, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 22230.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 285.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 323.0, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 79.51, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 332.5, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 63.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PHYSICAL THERAPY EVAL HIGH COMPLEXITY", "code_information": [{"code": "97163", "type": "CPT"}, {"code": "5097163", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 475.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PHYSICAL THERAPY EVAL LOW COMPLEXITY", "code_information": [{"code": "97161", "type": "CPT"}, {"code": "5097161", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 475.0, "estimated_discounted_cash": 436.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PHYSICAL THERAPY EVAL MODERATE COMPLEXI", "code_information": [{"code": "97162", "type": "CPT"}, {"code": "5097162", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 475.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PHYSICAL THERAPY RE-EVAL", "code_information": [{"code": "97002", "type": "CPT"}, {"code": "5097002", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PHYSICAL THERAPY RE-EVAL ESTABLISH POC", "code_information": [{"code": "97164", "type": "CPT"}, {"code": "5097164", "type": "CDM"}, {"code": "424", "type": "RC"}], "standard_charges": [{"gross_charge": 274.0, "setting": "both", "billing_class": "facility"}], "modifiers": "GP"}, {"description": "PHYTONADIONE (VIT K) 10MG/ML 1ML", "code_information": [{"code": "3000186", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 172.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PIERCE EARLOBES", "code_information": [{"code": "69090", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61250", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & EXPLORE", "code_information": [{"code": "61253", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PIERCE SKULL & REMOVE CLOT", "code_information": [{"code": "61154", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", 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"fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSN ASF PS 10MM VE L 3-5 CD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90013482", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 1048.95, "maximum": 132678.0, "gross_charge": 2835.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2353.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1927.8, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 1048.95, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 132678.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1701.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1927.8, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1984.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSN ASF PS 11MM VE L 10-11 CD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "90025603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 971.25, "maximum": 122850.0, "gross_charge": 2625.0, "estimated_discounted_cash": 2657.55, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 2178.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 971.25, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 122850.0, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 1575.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 1785.0, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 1837.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PST VRT JT RPLCMT LMBR 1 SGM", "code_information": [{"code": "719T", "type": "CPT"}], "standard_charges": [{"minimum": 1379.0, "maximum": 1379.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1379.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 14 GENES", "code_information": [{"code": "173U", "type": "CPT"}], "standard_charges": [{"minimum": 419.55, "maximum": 419.55, "discounted_cash": 699.26, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 419.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GEN ALYS PANEL 15 GENES", "code_information": [{"code": "175U", "type": "CPT"}], "standard_charges": [{"minimum": 1202.48, "maximum": 1202.48, "discounted_cash": 2004.14, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GENOM ALYS PNL 15 GEN", "code_information": [{"code": "345U", "type": "CPT"}], "standard_charges": [{"minimum": 1202.48, "maximum": 1202.48, "discounted_cash": 2004.14, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC GENOM ALYS PNL 15 GEN", "code_information": [{"code": "411U", "type": "CPT"}], "standard_charges": [{"minimum": 1202.48, "maximum": 1202.48, "discounted_cash": 2004.14, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1202.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC MOOD DO MRNA 144 GENES", "code_information": [{"code": "291U", "type": "CPT"}], "standard_charges": [{"minimum": 1579.5, "maximum": 1579.5, "discounted_cash": 2632.5, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC STRS DO MRNA 72 GENES", "code_information": [{"code": "292U", "type": "CPT"}], "standard_charges": [{"minimum": 1579.5, "maximum": 1579.5, "discounted_cash": 2632.5, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1579.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYC SUICIDAL IDEA MRNA 54", "code_information": [{"code": "293U", "type": "CPT"}], "standard_charges": [{"minimum": 684.0, "maximum": 684.0, "discounted_cash": 1140.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 684.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCHOSES", "code_information": [{"code": "885", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10543.14, "maximum": 10543.14, "discounted_cash": 14410.73, "setting": "inpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 10543.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PSYCL TST EVAL PHYS/QHP 1ST", "code_information": [{"code": "96130", "type": "CPT"}], "standard_charges": [{"minimum": 88.66, "maximum": 88.66, "discounted_cash": 311.51, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 88.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL TST EVAL PHYS/QHP EA", "code_information": [{"code": "96131", "type": "CPT"}], "standard_charges": [{"minimum": 67.5, "maximum": 67.5, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 67.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST PHY/QHP 1ST", "code_information": [{"code": "96136", "type": "CPT"}], "standard_charges": [{"minimum": 19.96, "maximum": 19.96, "discounted_cash": 191.94, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 19.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PSYCL/NRPSYC TST PHY/QHP EA", "code_information": [{"code": "96137", "type": "CPT"}], "standard_charges": [{"minimum": 15.73, "maximum": 15.73, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 15.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT EVAL HIGH COMPLEX 45 MIN", "code_information": [{"code": "97163", "type": "CPT"}], "standard_charges": [{"minimum": 63.61, "maximum": 63.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 63.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT EVAL MOD COMPLEX 30 MIN", "code_information": [{"code": "97162", "type": "CPT"}], "standard_charges": [{"minimum": 63.61, "maximum": 63.61, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 63.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NEUROMUSC REEDUCATION", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "5097112", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 30.31, "maximum": 9406.8, "gross_charge": 201.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 166.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 136.68, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 74.37, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 9406.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 120.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 136.68, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 140.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT NEUROMUSC REEDUCATION", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "50971122", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 30.31, "maximum": 10249.2, "gross_charge": 219.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 181.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 148.92, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 81.03, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 10249.2, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 131.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 148.92, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 30.31, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 153.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT RE-EVAL EST PLAN CARE", "code_information": [{"code": "97164", "type": "CPT"}], "standard_charges": [{"minimum": 43.12, "maximum": 43.12, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 43.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PT SPEC ALG RX-ONC TX OPTION", "code_information": [{"code": "794T", "type": "CPT"}], "standard_charges": [{"minimum": 1492.0, "maximum": 1492.0, "discounted_cash": 85.11, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1492.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PT-FOCUSED HLTH RISK ASSMT", "code_information": [{"code": "96160", "type": "CPT"}], "standard_charges": [{"minimum": 3.48, "maximum": 3.48, "discounted_cash": 54.06, "setting": "outpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 3.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTA GAIT TRAINING THERAPY", "code_information": [{"code": "97116", "type": "CPT"}, {"code": "50971162", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 25.68, "maximum": 6130.8, "gross_charge": 131.0, "estimated_discounted_cash": 166.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 108.73, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 89.08, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 48.47, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 6130.8, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 78.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 89.08, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 25.68, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 91.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTA THERAPEUTIC ACTIVITIES", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "50975302", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 31.6, "maximum": 5990.4, "gross_charge": 128.0, "estimated_discounted_cash": 161.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 106.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 87.04, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 47.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 5990.4, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 76.8, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 87.04, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 89.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PTA THERAPEUTIC EXERCISE", "code_information": 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"standard_charge_dollar": 495.6, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 561.68, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 5612.43, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 3741.62, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 669.89, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 578.2, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 3741.62, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7929.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL& 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"National Advantage", "standard_charge_dollar": 9623.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 7883.92, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 4289.78, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1940.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 542599.2, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 4010.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 6956.4, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 7883.92, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2910.99, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 1940.66, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 1237.81, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 8115.8, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1940.66, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 5456.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"minimum": 11751.0, "maximum": 11751.0, "discounted_cash": 32089.8, "setting": "outpatient", "payers_information": 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"BHP", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1940.66, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 208119.6, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 2323.0, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 2668.2, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 3023.96, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Commercial", "standard_charge_dollar": 2910.99, "methodology": "fee schedule"}, {"payer_name": "Geisinger Health Plan", "plan_name": "Medicare Replacement", "standard_charge_dollar": 1940.66, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 572.79, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 3112.9, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 81.89, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 1940.66, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 2728.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RNL FUNCJ PANEL", "code_information": [{"code": "80069", "type": "CPT"}, {"code": "380069", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 7.81, "maximum": 4539.6, "gross_charge": 97.0, "discounted_cash": 13.02, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 80.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature 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"methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 7.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RNL NDSC NFROS/PYELOSTOMY RESCJ TUM", "code_information": [{"code": "50562", "type": "CPT"}, {"code": "650562", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 550.93, "maximum": 542599.2, "gross_charge": 11594.0, "discounted_cash": 13656.84, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 8777.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 9623.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 7883.92, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 4289.78, "methodology": "fee 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"fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "standard_charge_dollar": 8115.8, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 550.93, "methodology": "fee schedule"}, {"payer_name": "Unison", "plan_name": "Medicare Advantage", "standard_charge_dollar": 8777.41, "methodology": "fee schedule"}, {"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 1890.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "RNL NDSC NFROT/PLOT W/ENDOPLOT", "code_information": [{"code": "50575", "type": "CPT"}, {"code": "650575", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 738.71, "maximum": 434210.4, "gross_charge": 9278.0, "discounted_cash": 7735.22, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "MEDICARE", "standard_charge_dollar": 4930.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"gross_charge": 870.0, "discounted_cash": 313.98, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 722.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 591.6, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 321.9, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 40716.0, "methodology": "fee schedule"}, {"payer_name": "Captial Blue Cross", "plan_name": "All Plans", "standard_charge_dollar": 192.72, "methodology": "case rate"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 522.0, "methodology": "fee schedule"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "standard_charge_dollar": 591.6, "methodology": "fee schedule"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", 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"AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "ROBT LIN-RADSURG FRACTX 2-5", "code_information": [{"code": "G0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 7929.0, "maximum": 7929.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", 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964.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SET DISPOSABLE KNEE OUTSIDEIN FOR MENISC", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "2501822", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 110.63, "maximum": 13993.2, "gross_charge": 299.0, "estimated_discounted_cash": 668.4, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "standard_charge_dollar": 248.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "standard_charge_dollar": 203.32, "methodology": "fee schedule"}, {"payer_name": "BHP", "plan_name": "All Commercial", "standard_charge_dollar": 110.63, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "standard_charge_dollar": 13993.2, "methodology": "fee schedule"}, {"payer_name": "DEVON", "plan_name": "All Plans", "standard_charge_dollar": 179.4, "methodology": "fee 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"billing_class": "facility"}]}, {"description": "Schizophrenia, Major", "code_information": [{"code": "750.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5132.53, "maximum": 5132.53, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 5132.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Schizophrenia, Minor", "code_information": [{"code": "750.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2391.15, "maximum": 2391.15, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2391.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Schizophrenia, Moderate", "code_information": [{"code": "750.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 3070.34, "maximum": 3070.34, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": 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"inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2175.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Seizure, Moderate", "code_information": [{"code": "53.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2712.36, "maximum": 2712.36, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2712.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Seizure, Severe", "code_information": [{"code": "53.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8677.93, "maximum": 8677.93, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 8677.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Septicemia And Disseminated Infections, Major", "code_information": [{"code": "720.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4534.32, "maximum": 4534.32, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 4534.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Septicemia And Disseminated Infections, Minor", "code_information": [{"code": "720.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2292.3, "maximum": 2292.3, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2292.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Septicemia And Disseminated Infections, Moderate", "code_information": [{"code": "720.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2905.35, "maximum": 2905.35, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2905.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Septicemia And Disseminated Infections, Severe", "code_information": [{"code": "720.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8886.44, "maximum": 8886.44, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 8886.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 100 Mcg/0.5ml Dosage, For Intramuscular Use", "code_information": [{"code": "91301", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Severe Acute Respiratory Syndrome Coronavirus 2 (Covid-19) Vaccine, Mrna-Lnp, Spike Protein, Preservative Free, 30 Mcg/0.3ml Dosage, Diluent Reconstituted, For Intramuscular Use", "code_information": [{"code": "91300", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "National Advantage", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 83.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "AETNA", "plan_name": "Signature Administrators", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BHP", "plan_name": "All Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 37.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 4680.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "DEVON", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 60.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "FIRST HEALTH", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 68.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HIGHMARK", "plan_name": "All Plans", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}, {"payer_name": "TRICARE", "plan_name": "All Plans", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Shoulder And Elbow Joint Replacement, Major", "code_information": [{"code": "322.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9394.57, "maximum": 9394.57, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 9394.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shoulder And Elbow Joint Replacement, Minor", "code_information": [{"code": "322.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5833.65, "maximum": 5833.65, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 5833.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shoulder And Elbow Joint Replacement, Moderate", "code_information": [{"code": "322.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6509.46, "maximum": 6509.46, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 6509.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shoulder And Elbow Joint Replacement, Severe", "code_information": [{"code": "322.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13206.85, "maximum": 13206.85, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 13206.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement, Major", "code_information": [{"code": "315.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9364.87, "maximum": 9364.87, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 9364.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement, Minor", "code_information": [{"code": "315.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4310.29, "maximum": 4310.29, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 4310.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement, Moderate", "code_information": [{"code": "315.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6297.57, "maximum": 6297.57, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 6297.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement, Severe", "code_information": [{"code": "315.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 16432.73, "maximum": 16432.73, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 16432.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Sickle Cell Anemia Crisis, Major", "code_information": [{"code": "662.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4464.48, "maximum": 4464.48, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 4464.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Sickle Cell Anemia Crisis, Minor", "code_information": [{"code": "662.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2136.08, "maximum": 2136.08, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2136.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Sickle Cell Anemia Crisis, Moderate", "code_information": [{"code": "662.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2916.82, "maximum": 2916.82, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2916.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Sickle Cell Anemia Crisis, Severe", "code_information": [{"code": "662.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 9274.45, "maximum": 9274.45, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 9274.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Signs, Symptoms And Other Factors Influencing Health Status, Major", "code_information": [{"code": "861.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 3797.44, "maximum": 3797.44, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 3797.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Signs, Symptoms And Other Factors Influencing Health Status, Minor", "code_information": [{"code": "861.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 1918.46, "maximum": 1918.46, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 1918.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Signs, Symptoms And Other Factors Influencing Health Status, Moderate", "code_information": [{"code": "861.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2524.09, "maximum": 2524.09, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2524.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Signs, Symptoms And Other Factors Influencing Health Status, Severe", "code_information": [{"code": "861.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6224.02, "maximum": 6224.02, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 6224.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Silicone Sheeting, 0.010 Thick, 2 x 3", "code_information": [{"code": "2502938", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 375.0, "setting": "both", "billing_class": "facility"}]}, {"description": "Silicone Sheeting, 0.040 Thick, 2 x 3", "code_information": [{"code": "2502939", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 436.0, "setting": "both", "billing_class": "facility"}]}, {"description": "Skin Graft For Skin And Subcutaneous Tissue Diagnoses, Major", "code_information": [{"code": "361.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 11829.92, "maximum": 11829.92, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 11829.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Graft For Skin And Subcutaneous Tissue Diagnoses, Minor", "code_information": [{"code": "361.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 6120.1, "maximum": 6120.1, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 6120.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Graft For Skin And Subcutaneous Tissue Diagnoses, Moderate", "code_information": [{"code": "361.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7584.08, "maximum": 7584.08, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 7584.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Graft For Skin And Subcutaneous Tissue Diagnoses, Severe", "code_information": [{"code": "361.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 25454.13, "maximum": 25454.13, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 25454.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses, Major", "code_information": [{"code": "312.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 13910.33, "maximum": 13910.33, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 13910.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses, Minor", "code_information": [{"code": "312.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 5491.86, "maximum": 5491.86, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 5491.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses, Moderate", "code_information": [{"code": "312.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 8449.85, "maximum": 8449.85, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 8449.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses, Severe", "code_information": [{"code": "312.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 26271.31, "maximum": 26271.31, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 26271.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Ulcers, Major", "code_information": [{"code": "380.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4213.79, "maximum": 4213.79, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 4213.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Ulcers, Minor", "code_information": [{"code": "380.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2120.56, "maximum": 2120.56, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2120.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Ulcers, Moderate", "code_information": [{"code": "380.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 2698.19, "maximum": 2698.19, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 2698.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Skin Ulcers, Severe", "code_information": [{"code": "380.4", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7743.33, "maximum": 7743.33, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 7743.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Specialty Services Observation Hours", "code_information": [{"code": "762", "type": "RC"}], "standard_charges": [{"minimum": 4087.0, "maximum": 4087.0, "setting": "outpatient", "payers_information": [{"payer_name": "United", "plan_name": "Commercial", "standard_charge_dollar": 4087.0, "methodology": "case rate"}, {"payer_name": "United", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 11.25, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Spinal Disorders And Injuries, Major", "code_information": [{"code": "40.3", "type": "APR-DRG"}], "standard_charges": [{"minimum": 7689.68, "maximum": 7689.68, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 7689.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Spinal Disorders And Injuries, Minor", "code_information": [{"code": "40.1", "type": "APR-DRG"}], "standard_charges": [{"minimum": 4029.23, "maximum": 4029.23, "setting": "inpatient", "payers_information": [{"payer_name": "Unison", "plan_name": "Med Plus", "standard_charge_dollar": 4029.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Spinal Disorders And Injuries, Moderate", "code_information": [{"code": "40.2", "type": "APR-DRG"}], "standard_charges": [{"minimum": 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