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"standard_charges": [{"gross_charge": 547.8, "discounted_cash": 147.91, "setting": "both", "billing_class": "facility"}]}, {"description": "2.4MM TI CONDYLAR PLATE 8 HOLES/57MM - RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "449.916", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 87.0, "discounted_cash": 23.49, "setting": "both", "billing_class": "facility"}]}, {"description": "2.4MM TI CORTEX SCREW SLF-TPNG WITH T8 STARDRIVE RECESS 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.768", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 192.03, "discounted_cash": 51.85, "setting": "both", "billing_class": "facility"}]}, {"description": "2.5 TRILOCK WRIST FUSION PL SHORT BEND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A-4760.02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6471.0, "discounted_cash": 1747.17, "setting": "both", "billing_class": "facility"}]}, {"description": "2.7MM TI CONDYLAR PLATE 7 HOLES/57MM-LEFT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.61", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1060.98, "discounted_cash": 286.46, "setting": "both", "billing_class": "facility"}]}, {"description": "2.7MM TI PLATE 3 HOLE/ 34MM OBLIQUE-RIGHT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "442.34", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 196.62, "discounted_cash": 53.09, "setting": "both", "billing_class": "facility"}]}, {"description": "2.8 DRILL BIT QC 135 45 CALIBRATION", "code_information": [{"code": "3.133.106", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.59, "discounted_cash": 139.21, "setting": "both", "billing_class": "facility"}]}, {"description": "2.8 TAP 75MM AO", "code_information": [{"code": "A-3839", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 998.25, "discounted_cash": 269.53, "setting": "both", "billing_class": "facility"}]}, {"description": "2.8MM PERCUTANEOUS DRILL BIT F/LCP PL QC/200MM/100MM CALIB", "code_information": [{"code": "324.214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 733.1, "discounted_cash": 197.94, "setting": "both", "billing_class": "facility"}]}, {"description": "20.0X380MM BULLET-TIP REAMER", "code_information": [{"code": "456225", "type": "CDM"}], "standard_charges": [{"gross_charge": 1932.0, "discounted_cash": 521.64, "setting": "both", "billing_class": "facility"}]}, {"description": "20.5X380MM BULLET-TIP REAMER", "code_information": [{"code": "456226", "type": "CDM"}], "standard_charges": [{"gross_charge": 1932.0, "discounted_cash": 521.64, "setting": "both", "billing_class": "facility"}]}, {"description": "2019-NCOV DIAGNOSTIC P", "code_information": [{"code": "U0001", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.33, "maximum": 32.33, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 32.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "21.0X380MM BULLET-TIP REAMER", "code_information": [{"code": "456227", "type": "CDM"}], "standard_charges": [{"gross_charge": 1932.0, "discounted_cash": 521.64, "setting": "both", "billing_class": "facility"}]}, {"description": "21.5X380MM BULLET-TIP REAMER", "code_information": [{"code": "456228", "type": "CDM"}], "standard_charges": [{"gross_charge": 1932.0, "discounted_cash": 521.64, "setting": "both", "billing_class": "facility"}]}, {"description": "22.0X380MM BULLET-TIP REAMER", "code_information": [{"code": "456229", "type": "CDM"}], "standard_charges": [{"gross_charge": 1932.0, "discounted_cash": 521.64, "setting": "both", 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"code_information": [{"code": "456231", "type": "CDM"}], "standard_charges": [{"gross_charge": 1932.0, "discounted_cash": 521.64, "setting": "both", "billing_class": "facility"}]}, {"description": "23.5X380MM BULLET-TIP REAMER", "code_information": [{"code": "456232", "type": "CDM"}], "standard_charges": [{"gross_charge": 1932.0, "discounted_cash": 521.64, "setting": "both", "billing_class": "facility"}]}, {"description": "24.0X380MM BULLET-TIP REAMER", "code_information": [{"code": "456233", "type": "CDM"}], "standard_charges": [{"gross_charge": 1932.0, "discounted_cash": 521.64, "setting": "both", "billing_class": "facility"}]}, {"description": "25MM ART. 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33251", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "33261", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE HEART DYSRHYTHM FOCUS", "code_information": [{"code": "93650", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 12956.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 11832.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 12956.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE INF TURBINATE SUBMUC", "code_information": [{"code": "30802", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLATE PULM TUMOR PERQ CRYBL", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABLTJ PERC LXTR/PERPH NRV", "code_information": [{"code": "441T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 4743.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABO Group by Blood Center 86900", "code_information": [{"code": "86900", "type": "CPT"}, 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59851", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", 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"standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ABORTION", "code_information": [{"code": "59857", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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[{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORABLE HEMOSTATIC SURGICEL ORIGINAL  4INX8 IN 1952S", "code_information": [{"code": "1952S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 202.95, "discounted_cash": 54.8, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN  SPONGE (SURGIFOAM) SIZE 12-7", "code_information": [{"code": "MED0001", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 25.46, "discounted_cash": 6.87, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN POWDER (SURGIFOAM) KIT 1GM", "code_information": [{"code": "MED0002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 204.23, "discounted_cash": 55.14, "setting": "both", "billing_class": "facility"}]}, {"description": "ABSORBABLE GELATIN POWDER; 1GM ENVELOPE", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF FOREARM", "code_information": [{"code": "25915", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF HAND", "code_information": [{"code": "25927", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AMPUTATION OF LEG AT HIP", "code_information": [{"code": "27295", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 247.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANS PARASYMP & SYMP W/TILT", "code_information": [{"code": "95924", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANT THRC VRT BODY TETHRG <7", "code_information": [{"code": "22836", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANTENNA PRGRMMR PT EXTERNAL TO BE USED W/ 37742 OR 7439 PATIENT PROGRAMMER", "code_information": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AORTIC SUSPENSION", "code_information": [{"code": "33800", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE DUP/DELET VARIANTS", "code_information": [{"code": "81203", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 180.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE FULL SEQUENCE", "code_information": [{"code": "81201", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 702.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APC GENE KNOWN FAM VARIANTS", "code_information": [{"code": "81202", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 252.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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[{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLASMA", "code_information": [{"code": "36514", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APHERESIS PLATELETS", "code_information": [{"code": "36513", "type": "CPT"}], "standard_charges": 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rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP MLTPLN UNI XTRNL FIX 1ST", "code_information": [{"code": "20696", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP TOPICAL FLUORIDE VARNISH", "code_information": [{"code": "99188", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. OF MULTIPLANE UNI. EXT. FIX W/STEREOTACTIC COMP. ASSIST. ADJ. 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OF SKIN GRAFT TO TRUNK/ARMS/LEGS AREA UP TO 100SQ CM EA. 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SKIN SUB. GRAFT HEAD/GENITALIA/HND/FT/DIG. UP TO 100SQ CM EA ADD 25SQ CM 15276", "code_information": [{"code": "15276", "type": "CPT"}, {"code": "23179559", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3860.0, "discounted_cash": 1042.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 2895.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APP. SKIN SUB. 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": "29035", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF BODY CAST", "code_information": [{"code": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF FINGER SPLINT", "code_information": [{"code": "29131", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATION OF HIP CASTS", "code_information": [{"code": "29325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLICATOR ARISTA 14 CM EXTENDED ENT SURGERY FLEXITIP", "code_information": [{"code": "AM0004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.25, "discounted_cash": 15.19, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR BELLOW 5GM SPRY HEMOSTATIC FOR DEL OF ARISTA AH ABSORBL HEMOSTATIC PO", "code_information": [{"code": "SM0007-USA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 610.5, "discounted_cash": 164.84, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CAGE 6IN METAL FOR CHILDREN AND ADULTS FINGERS AND TOES", "code_information": [{"code": "GL231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.84, "discounted_cash": 23.72, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORAPREP 26ML 930800", "code_information": [{"code": "930800", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.29, "discounted_cash": 8.18, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORAPREP 3ML CLEAR 930400", "code_information": [{"code": "930400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.61, "discounted_cash": 1.24, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 10.5 ML ORANGE SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.01, "discounted_cash": 5.13, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 26 ML ORANGE SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.85, "discounted_cash": 8.33, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 26 ML TEAL SCRUB CHLORAPREP LF", "code_information": [{"code": "260825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.91, "discounted_cash": 10.51, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLORHEXIDINE GLUCONATE 3 ML ORANGE TINT SKIN PREP CHLORAPREP LF", "code_information": [{"code": "260415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.65, "discounted_cash": 1.26, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR CHLRPRP ORNG TNTD 10.5ML 930715", "code_information": [{"code": "930715", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17.65, "discounted_cash": 4.77, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR DUPLOSPRAY MIS 40CM", "code_information": [{"code": "601130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.7, "discounted_cash": 42.85, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR EXTENDID TIP 5.1MM X 8MM", "code_information": [{"code": "205108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 625.88, "discounted_cash": 168.99, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR FLOSEAL ENDOSCOPIC", "code_information": [{"code": "600125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.0, "discounted_cash": 24.3, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR FLOSEAL ENDOSCOPIC 0600225", "code_information": [{"code": "600225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 194.79, "discounted_cash": 52.59, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR FLOSEAL MLBL TRM TIP", "code_information": [{"code": "1502186", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SPNG 3 ML CLR SPONGE TIP 1-STEP PLASTIC SHAFT CHLORAPREP STRL", "code_information": [{"code": "260400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.9, "discounted_cash": 1.05, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SURG 38CM XL ABSORBL HEMOSTATIC PARTICLES ARISTA FLEXITIP", "code_information": [{"code": "AM0005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 171.19, "discounted_cash": 46.22, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR SURGICEL ENDOSCOPIC 3123SPEA", "code_information": [{"code": "3123SPEA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.88, "discounted_cash": 29.67, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATOR TISSEEL 40CM SPRAY SET DUAL LUMEN TUBING FILLER DUPLOSPRAY MIS REGULATOR", "code_information": [{"code": "600030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 261.92, "discounted_cash": 70.72, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLICATR MBO CHLORAPREP ORANGE TINT 3ML 930415", "code_information": [{"code": "930415", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.88, "discounted_cash": 1.32, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIED 12X150 NON BLADE", "code_information": [{"code": "CFF71", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 245.14, "discounted_cash": 66.19, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 11.5IN MED PREMIUM SURGICLIP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "134053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.43, "discounted_cash": 133.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 11.5IN SM PREMIUM SURGICLIP DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "134031", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 494.43, "discounted_cash": 133.5, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 5MM MULTIPLE ENDO ROTATING LF STRL DISP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "ETHEL5ML", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 216.21, "discounted_cash": 58.38, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 9.75IN MD PREMIUM SURGICLIP II SUPER INTERLOCK BLUE", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134051", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 463.14, "discounted_cash": 125.05, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP 9IN SM PREMIUM SURGICLIP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134046", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 446.32, "discounted_cash": 120.51, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP ENDO 5MM EL5ML", "code_information": [{"code": "EL5ML", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.21, "discounted_cash": 58.38, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP ENDO CLIP II 10MM TITANIUM 176657", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "176657", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 548.15, "discounted_cash": 148.0, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP 20SMALL 9 3/8 MCS20", "code_information": [{"code": "MCS20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 117.09, "discounted_cash": 31.61, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MD/LG STERILE ER320", "code_information": [{"code": "ER320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.82, "discounted_cash": 63.13, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20LARGE 13 MCL20", "code_information": [{"code": "MCL20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 163.12, "discounted_cash": 44.04, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20MD 11 MCM20", "code_information": [{"code": "MCM20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.46, "discounted_cash": 34.14, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP LIGACLIP MULTI 20MD 9 3/8 MSM20", "code_information": [{"code": "MSM20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.2, "discounted_cash": 32.45, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP MED LNG 30 CLIP LIGACLIP MCA LIGACLIP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "MCM30", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 146.69, "discounted_cash": 39.61, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER CLIP SURGICLIP L-13.0 AUTO G 134048", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "134048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 446.32, "discounted_cash": 120.51, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLIER MENISCAL CLIP REPAIR KNEE RAPIDLOC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "228000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 537.9, "discounted_cash": 145.23, "setting": "both", "billing_class": "facility"}]}, {"description": "APPLY FOREARM SPLINT", "code_information": [{"code": "29126", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY HAND/WRIST CAST", "code_information": [{"code": "29085", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT COMPL", "code_information": [{"code": "77763", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 377.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT INTERM", "code_information": [{"code": "77762", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 292.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY INTRCAV RADIAT SIMPLE", "code_information": [{"code": "77761", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 249.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY LONG LEG CAST BRACE", "code_information": [{"code": "29358", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"billing_class": "facility"}]}, {"description": "APPLY MULTLAY COMPRS LWR LEG", "code_information": [{"code": "29581", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY R&L PULM ART BANDS", "code_information": [{"code": "33620", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY REM FIXATION DEVICE", "code_information": [{"code": "20660", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY RIGID LEG CAST", "code_information": [{"code": "29445", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29405", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SHORT LEG CAST", "code_information": [{"code": "29435", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "APPLY SRS HEADFRAME ADD-ON", "code_information": [{"code": "61800", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 41468.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AQAPRN-4 ANTB FLO CYTMTRY EA", "code_information": [{"code": "86053", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.85, "methodology": "fee 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970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP CAROTID-VERTEBRAL", "code_information": [{"code": "35642", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP COMMON IPSI CAROTID", "code_information": [{"code": "35601", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEM-ANT-POST TIB/PRL", "code_information": [{"code": "35566", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP FEMORAL-FEMORAL", "code_information": [{"code": "35661", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AOR/CAROT/INNOM", "code_information": [{"code": "35526", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORCEL/AORMESEN", "code_information": [{"code": "35531", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTBIFEMORAL", "code_information": [{"code": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOBI-ILIAC", "code_information": [{"code": "35538", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AORTOILIAC", "code_information": [{"code": "35537", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"description": "ART BYP GRFT AORTORENAL", "code_information": [{"code": "35560", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-BRACHIAL", "code_information": [{"code": "35522", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL-FEMORAL", "code_information": [{"code": "35521", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILL/FEM/FEM", "code_information": [{"code": "35533", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT AXILLARY-AXILRY", "code_information": [{"code": "35518", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT BRACHIAL-BRCHL", "code_information": [{"code": "35525", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-BRCHIAL", "code_information": [{"code": "35510", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT CAROTID-VERTBRL", "code_information": [{"code": "35508", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-FEMORAL", "code_information": [{"code": "35558", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT FEM-POPLITEAL", "code_information": [{"code": "35556", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT IPSILAT CAROTID", "code_information": [{"code": "35501", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SPLENORENAL", "code_information": [{"code": "35536", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-BRCHIAL", "code_information": [{"code": "35512", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-CAROTID", "code_information": [{"code": "35506", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP GRFT SUBCLAV-SUBCLAV", "code_information": [{"code": "35511", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIO-MESENTERIC", "code_information": [{"code": "35633", "type": 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690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIOILIAC", "code_information": [{"code": "35663", "type": 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP ILIORENAL", "code_information": [{"code": "35634", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP POP-TIBL-PRL-OTHER", "code_information": [{"code": "35671", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SPENORENAL", "code_information": [{"code": "35636", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-AXILLARY", "code_information": [{"code": "35616", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-SUBCLAVIAN", "code_information": [{"code": "35612", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART BYP SUBCLAV-VERTEBRL", "code_information": [{"code": "35645", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART PRESSURE WAVEFORM ANALYS", "code_information": [{"code": "93050", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ART TRNSPOSJ VERTBRL CAROTID", "code_information": [{"code": "35691", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAY EACH VESSEL", "code_information": [{"code": "75774", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 235.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ABDOMEN", "code_information": [{"code": "75726", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 280.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5448.15, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENAL GLAND", "code_information": [{"code": "75731", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 283.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ADRENALS", "code_information": [{"code": "75733", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 327.65, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARM/LEG", "code_information": [{"code": "75710", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 284.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS ARMS/LEGS", "code_information": [{"code": "75716", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 322.09, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS CHEST", "code_information": [{"code": "75756", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 287.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75741", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 251.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNG", "code_information": [{"code": "75746", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 270.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS LUNGS", "code_information": [{"code": "75743", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 263.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS PELVIS", "code_information": [{"code": "75736", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 281.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5448.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY X-RAYS SPINE", "code_information": [{"code": "75705", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 281.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5448.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN AUTOGRAFT", "code_information": [{"code": "36825", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTERY-VEIN NONAUTOGRAFT", "code_information": [{"code": "36830", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ARTHODESIS SACROILIAC JOINT INC. GRAFT/ INST. 27280", "code_information": [{"code": "27280", "type": "CPT"}, {"code": "2034629", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 12262.5, "gross_charge": 16350.0, "discounted_cash": 4414.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV PARASYM INERVJ", "code_information": [{"code": "95921", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTONOMIC NRV SYST FUNJ TEST", "code_information": [{"code": "95923", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, 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[{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 315.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AUTOPSY (NECROPSY) COMPLETE", "code_information": [{"code": "88027", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 336.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "AV FISTULA REVISION", "code_information": [{"code": "36833", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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{"description": "BI-ANGULAR/BI-POLAR HD TRL 22.2MM STD", "code_information": [{"code": "408408", "type": "CDM"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 101.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BI-ANGULAR/BI-POLAR HD TRL 22MM STD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "408409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 852.15, "discounted_cash": 230.08, "setting": "both", "billing_class": "facility"}]}, {"description": "BILE ACIDS CHOLYLGLYCINE", "code_information": [{"code": "82240", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47553", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BILIARY ENDOSCOPY THRU SKIN", "code_information": [{"code": "47555", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.0MM SCOPE CHANNELS Mini Forceps 129-0175 Oval Yellow 160 2", "code_information": [{"code": "BF40021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.54, "discounted_cash": 14.46, "setting": "both", 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"BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 128-5670 Alligator Blue 230 2.8", "code_information": [{"code": "BF40206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.44, "discounted_cash": 6.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0179 Oval Orange 180 2.8", "code_information": [{"code": "BF40081", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps 129-0184 Alligator Orange 180 2.8", "code_information": [{"code": "BF40191", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS 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Blue 230 2.8", "code_information": [{"code": "BF40441", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps Serrated 132-9020 Serrated Orange 180 2.8", "code_information": [{"code": "BF40431", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 128-5669 Oval Blue 230 2.8", "code_information": [{"code": "BF40126", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.44, "discounted_cash": 6.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 128-5671 Alligator Blue 230 2.8", "code_information": [{"code": "BF40236", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.44, "discounted_cash": 6.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0180 Oval Orange 180 2.8", "code_information": [{"code": "BF40111", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0185 Alligator Orange 180 2.", "code_information": [{"code": "BF40221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0678 Oval Blue 230 2.8", "code_information": [{"code": "BF40121", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike 129-0680 Alligator Blue 230 2.8", "code_information": [{"code": "BF40231", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated  131-2211 Serrated Blue", "code_information": [{"code": "BF40426", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.44, "discounted_cash": 6.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated  132-9019 Serrated Blue", "code_information": [{"code": "BF40421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 2.8MM SCOPE CHANNELS Standard Forceps With Spike Serrated 132-9018 Serrated Orang", "code_information": [{"code": "BF40411", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.87, "discounted_cash": 7.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps 129-0177 Oval Blue 230 3.2", "code_information": [{"code": "BF40061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.02, "discounted_cash": 12.97, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps 129-0182 Alligator Blue 230 3.2", "code_information": [{"code": "BF40171", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.02, "discounted_cash": 12.97, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS FOR 3.2MM SCOPE CHANNELS Jumbo Biopsy Forceps With Spike 129-0178 Oval Blue 230 3.2", "code_information": [{"code": "BF40071", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.02, "discounted_cash": 12.97, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS HOT Biopsy Forcep Hot Lower 129-0681 Oval Blue 230 2.8", "code_information": [{"code": "HF48521", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.54, "discounted_cash": 14.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FORCEPS HOT Biopsy Forceps Hot Lower Alligator 131-2213 Alligator Blue 230 2.8", "code_information": [{"code": "HF48541", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.54, "discounted_cash": 14.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25065", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY FOREARM SOFT TISSUES", "code_information": [{"code": "25066", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF HIP JOINT", "code_information": [{"code": "27052", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SALIVARY GLAND", "code_information": [{"code": "42405", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SHOULDER JOINT", "code_information": [{"code": "23100", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF SOFT TISSUES", "code_information": [{"code": "27040", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF THYROID", "code_information": [{"code": "60100", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF TONGUE", "code_information": [{"code": "41100", 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF UPPER NOSE/THROAT", "code_information": [{"code": "42806", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VAGINA", "code_information": [{"code": "57105", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 5016.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BIOPSY OF VULVA/PERINEUM", "code_information": [{"code": "56606", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, 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62.09, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 1.8MM X 110MM MINI QUICK COUPLING NON STRL W/ DEPTH MARKINSTR", "code_information": [{"code": "310.509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 631.22, "discounted_cash": 170.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 2MM 140/115MM 3 FLUTE QUICK COUPLING W/ DOUBLE DEPTH MARKINGINSTR", "code_information": [{"code": "323.062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 631.22, "discounted_cash": 170.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT DRLL 2MM X 75MM STRYKER J LATCH COUPLING FOR USE W/ MODULAR HND SYS FOR 1 MM", "code_information": [{"code": "310.203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.05, "discounted_cash": 25.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT 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"discounted_cash": 179.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT SPADE 1 PEG", "code_information": [{"code": "32-347839", "type": "CDM"}], "standard_charges": [{"gross_charge": 228.0, "discounted_cash": 61.56, "setting": "both", "billing_class": "facility"}]}, {"description": "BIT SPADE TIP 3.5MM KGP035", "code_information": [{"code": "KGP035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 472.6, "discounted_cash": 127.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BITE BLOCK 60FR W DENTAL RIM", "code_information": [{"code": "SBT-546-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "BITE BLOCK BITE-GARD DISP 1140.", "code_information": [{"code": "1140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.22, 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{"description": "BLADE CUTTER 5.5MM SHAVER FORMULA REPROCESS AGGRESSIVE PLUS", "code_information": [{"code": "375-564-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.9, "discounted_cash": 18.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE CUTTER 5.5MM SHAVER FORMULA RESECTOR", "code_information": [{"code": "375-562-000R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.9, "discounted_cash": 18.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DERMATOME ELECTRIC", "code_information": [{"code": "-8800-000-10", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.77, "discounted_cash": 27.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE DIAMOND 19.7MM X 100MM X .054MM REPLACE FOR STRYKER 2000INSTR", "code_information": [{"code": "516061", "type": "CDM"}, {"code": "272", "type": 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{"description": "BLADE GRINDLESS 64NO MINI ROUND TIP BEAVER VISITEC LFINSTR", "code_information": [{"code": "BEAVER6400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.88, "discounted_cash": 3.48, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HARMONIC 3MM  10CM TO 14CM HOOK TIP FOR USE WITH HPBLUE HANDPIECE SYNERGY BRAND", "code_information": [{"code": "SNGHK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 957.11, "discounted_cash": 258.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HARMONIC 3MM  4CM TO 9CM HOOK TIP FOR USE WITH HPBLUE HANDPIECE SYNERGY BRAND", "code_information": [{"code": "SNGHK2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 957.11, "discounted_cash": 258.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BLADE HEX 2.5MM", "code_information": [{"code": "405885", 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AUGMENTATION 80MM X 10MM FEMORAL POSTERIO RIGHT LAT LFT MEDIAL MAXIM", "code_information": [{"code": "145375", "type": "CDM"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 789.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 80MM X 6MM FEMORAL DIST LFT LAT RIGHT MEDIAL MAXIM", "code_information": [{"code": "145325", "type": "CDM"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 789.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 80MM X 6MM FEMORAL DIST RIGHT LAT LFT MEDIAL MAXIM", "code_information": [{"code": "145315", "type": "CDM"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 789.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 80MM X 6MM FEMORAL POST LFT LAT RIGHT MEDIAL MAXIM", "code_information": [{"code": "145345", "type": "CDM"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 789.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 80MM X 6MM FEMORAL POST RIGHT LAT LFT MEDIAL MAXIM", "code_information": [{"code": "145335", "type": "CDM"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 789.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 83MM X 10MM TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141766", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2907.0, "discounted_cash": 784.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 83MM X 6MM TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141746", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2907.0, "discounted_cash": 784.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 87MM X 10MM TIBIAL", "code_information": [{"code": "141767", "type": "CDM"}], "standard_charges": [{"gross_charge": 2907.0, "discounted_cash": 784.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 87MM X 6MM TIBIAL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "141747", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2907.0, "discounted_cash": 784.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 91MM X 10MM TIBIAL", "code_information": [{"code": "141768", "type": "CDM"}], "standard_charges": [{"gross_charge": 2907.0, "discounted_cash": 784.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK AUGMENTATION 91MM X 6MM TIBIAL", "code_information": [{"code": "141748", "type": "CDM"}], "standard_charges": [{"gross_charge": 2907.0, "discounted_cash": 784.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK BITE 20MM LG SCOPE SAVER MOUTHPIECE LF DISP", "code_information": [{"code": "429", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.46, "discounted_cash": 1.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK BITE ENDOSCOPY", "code_information": [{"code": "GIS-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.27, "discounted_cash": 2.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 55.0MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487130", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 57.5MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487131", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 60.0MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487132", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 62.5MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487133", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 65.0MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487134", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 65MM 1/8 SURFACE PIN", "code_information": [{"code": "32-347243", "type": "CDM"}], "standard_charges": [{"gross_charge": 4941.0, "discounted_cash": 1334.07, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 65MM SURFACE", "code_information": [{"code": "32-347223", "type": "CDM"}], "standard_charges": [{"gross_charge": 2433.0, "discounted_cash": 656.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 67.5MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487135", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 70.0MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487136", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 70MM SURFACE", "code_information": [{"code": "32-347225", "type": "CDM"}], "standard_charges": [{"gross_charge": 2433.0, "discounted_cash": 656.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 72.5MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487139", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 75.0MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487137", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 75MM SURFACE", "code_information": [{"code": "32-347226", "type": "CDM"}], "standard_charges": [{"gross_charge": 2433.0, "discounted_cash": 656.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 80.0MM SURFACE CHAMFER BLOCK VANGUARD", "code_information": [{"code": "32-487138", "type": "CDM"}], "standard_charges": [{"gross_charge": 9156.0, "discounted_cash": 2472.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CHAMFER 80MM SURFACE", "code_information": [{"code": "32-347227", "type": "CDM"}], "standard_charges": [{"gross_charge": 2433.0, "discounted_cash": 656.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CONTRAINED 80MM SURFACE ANT POSTERIOR", "code_information": [{"code": "32-347217", "type": "CDM"}], "standard_charges": [{"gross_charge": 1803.0, "discounted_cash": 486.81, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 5 DEGREE ANT POST FEMORAL OSS", "code_information": [{"code": "32-472635", "type": "CDM"}], "standard_charges": [{"gross_charge": 2298.0, "discounted_cash": 620.46, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 5 DEGREE FEMORAL REDUCED SZ ANT POST OSS", "code_information": [{"code": "32-472177", "type": "CDM"}], "standard_charges": [{"gross_charge": 1374.0, "discounted_cash": 370.98, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 55 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360704", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 55.0MM REV VANGUARD", "code_information": [{"code": "32-488100", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 55INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360715", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 57.5 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360705", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 57.5INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360716", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 60 4IN 1 VAMGAURD 360", "code_information": [{"code": "32-360706", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 60.0MM REV VANGUARD", "code_information": [{"code": "32-488102", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 60INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360717", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 60MM FEMORAL SLIDING FOURIN ONE MAXIM SI", "code_information": [{"code": "RD140530", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 62.5 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360707", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 62.5INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360718", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 65 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360708", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 65.0MM REV VANGUARD", "code_information": [{"code": "32-488104", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 65INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360719", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 67.5 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360709", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 67.5INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360720", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 70 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360710", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 70.0MM REV VANGUARD", "code_information": [{"code": "32-488106", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 70INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360721", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 72.5 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360711", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 72.5INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360722", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 75 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360712", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 75.0MM REV VANGUARD", "code_information": [{"code": "32-488108", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 75INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360723", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 80 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360713", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 80.0MM VANGUARD", "code_information": [{"code": "32-488110", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT 80INSERT 4IN 1 VANGAURD 360", "code_information": [{"code": "32-360724", "type": "CDM"}], "standard_charges": [{"gross_charge": 969.0, "discounted_cash": 261.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT ADJ DIST CUT WITHOUT HANDLE ATTCHMNT", "code_information": [{"code": "32-487002", "type": "CDM"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 1782.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT ANTEROMEDIALDISTAL CUT MP ELITE", "code_information": [{"code": "32-484000", "type": "CDM"}], "standard_charges": [{"gross_charge": 3936.0, "discounted_cash": 1062.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT AUGMENET VANGUARD", "code_information": [{"code": "32-488270", "type": "CDM"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT DIST CUT BLOCK  HANDLE ATTCHMNT", "code_information": [{"code": "32-487001", "type": "CDM"}], "standard_charges": [{"gross_charge": 4500.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT EXTRA SM UNIVERSAL POST OXFORD", "code_information": [{"code": "32-421070", "type": "CDM"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT LG UNIVERSAL POST OXFORD", "code_information": [{"code": "32-421073", "type": "CDM"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT MED UNIVERSAL POST OXFORD", "code_information": [{"code": "32-421072", "type": "CDM"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT REV DIST CUT VANGUARD", "code_information": [{"code": "32-488000", "type": "CDM"}], "standard_charges": [{"gross_charge": 3108.0, "discounted_cash": 839.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT SM UNIVERSAL POST OXFORD", "code_information": [{"code": "32-421071", "type": "CDM"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT TIBL RESECTION HEAD ANATOMIC LFT SIGNATURE VANGUARD MICROPLASTY", "code_information": [{"code": "RD140513", "type": "CDM"}], "standard_charges": [{"gross_charge": 1068.0, "discounted_cash": 288.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT TIBL RESECTION HEAD ANATOMIC RIGHT SIGNATURE VANGUARD MICROPLASTY", "code_information": [{"code": "RD140512", "type": "CDM"}], "standard_charges": [{"gross_charge": 1068.0, "discounted_cash": 288.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUT XL UNIVERSAL POST OXFORD", "code_information": [{"code": "32-421074", "type": "CDM"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUTTING 65MM FEMORAL MP SLIDING", "code_information": [{"code": "RD140531", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUTTING 70MM FEMORAL MP SLIDING", "code_information": [{"code": "RD140532", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK CUTTING 75MM FEMORAL MP SLIDING", "code_information": [{"code": "RD140533", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK DIST CUT VANGAURD 360", "code_information": [{"code": "32-360278", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK DIST SCORPIO TS", "code_information": [{"code": "75-1-0305", "type": "CDM"}], "standard_charges": [{"gross_charge": 2958.9, "discounted_cash": 798.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 55.0MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485150", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 55.0MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485100", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 55.0MM VANGUARD PREMIER", "code_information": [{"code": "32-487100", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 57.5MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485151", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 57.5MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485101", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 57.5MM VANGUARD PREMIER", "code_information": [{"code": "32-487101", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 60.0MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485152", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 60.0MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485102", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 60.0MM VANGUARD PREMIER", "code_information": [{"code": "32-487102", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 60MM RESECTION 4IN 1", "code_information": [{"code": "32-347533", "type": "CDM"}], "standard_charges": [{"gross_charge": 7296.0, "discounted_cash": 1969.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 62.5MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485153", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 62.5MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485103", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 62.5MM VANGUARD PREMIER", "code_information": [{"code": "32-487103", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 65.0MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485154", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 65.0MM VANGUARD PREMIER", "code_information": [{"code": "32-487104", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 65.5MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485104", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 65MM RESECTION 4IN 1", "code_information": [{"code": "32-347534", "type": "CDM"}], "standard_charges": [{"gross_charge": 7296.0, "discounted_cash": 1969.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 67.5MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485155", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 67.5MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485105", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 67.5MM VANGUARD PREMIER", "code_information": [{"code": "32-487105", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 70.0MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485156", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 70.0MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485106", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 70.0MM VANGUARD PREMIER", "code_information": [{"code": "32-487106", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 70MM RESECTION 4IN 1", "code_information": [{"code": "32-347535", "type": "CDM"}], "standard_charges": [{"gross_charge": 7296.0, "discounted_cash": 1969.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 72.5MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485159", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 72.5MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485110", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 72.5MM VANGUARD PREMIER", "code_information": [{"code": "32-487109", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 75.0MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485157", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 75.0MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485107", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 75.0MM VANGUARD PREMIER", "code_information": [{"code": "32-487107", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 75MM RESECTION 4IN 1", "code_information": [{"code": "32-347536", "type": "CDM"}], "standard_charges": [{"gross_charge": 7296.0, "discounted_cash": 1969.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 80.0MM 4IN 1 VANGUARD MICROPLASTY ELITE SLIDEX", "code_information": [{"code": "32-485158", "type": "CDM"}], "standard_charges": [{"gross_charge": 17187.0, "discounted_cash": 4640.49, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 80.0MM MICROPLASTY SLIDEX", "code_information": [{"code": "32-485108", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 80.0MM VANGUARD PREMIER", "code_information": [{"code": "32-487108", "type": "CDM"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL 80MM RESECTION 4IN 1", "code_information": [{"code": "32-347537", "type": "CDM"}], "standard_charges": [{"gross_charge": 7296.0, "discounted_cash": 1969.92, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL ANT REFERENCING DIST CUT VANGUARD", "code_information": [{"code": "32-485260", "type": "CDM"}], "standard_charges": [{"gross_charge": 3336.0, "discounted_cash": 900.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL EXTRA SM ANATOMIC 4IN 1 ASCENT", "code_information": [{"code": "32-379940", "type": "CDM"}], "standard_charges": [{"gross_charge": 4536.0, "discounted_cash": 1224.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL LG ANATOMIC 4IN 1 ASCENT", "code_information": [{"code": "32-379943", "type": "CDM"}], "standard_charges": [{"gross_charge": 4536.0, "discounted_cash": 1224.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL MED ANATOMIC 4IN 1 ASCENT", "code_information": [{"code": "32-379942", "type": "CDM"}], "standard_charges": [{"gross_charge": 4536.0, "discounted_cash": 1224.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL POST SCORPIO TS", "code_information": [{"code": "75-2-0305", "type": "CDM"}], "standard_charges": [{"gross_charge": 2958.9, "discounted_cash": 798.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL SM ANATOMIC 4IN 1 ASCENT", "code_information": [{"code": "32-379941", "type": "CDM"}], "standard_charges": [{"gross_charge": 4536.0, "discounted_cash": 1224.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK FEMORAL XL ANATOMIC 4IN 1 ASCENT", "code_information": [{"code": "32-379944", "type": "CDM"}], "standard_charges": [{"gross_charge": 4536.0, "discounted_cash": 1224.72, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK GUIDE 6 HOLE HEAD LFT FOR 2 COLUMN PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3.111.601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1063.05, "discounted_cash": 287.02, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK GUIDE 6 HOLE HEAD RIGHT FOR 2 COLUMN PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3.111.600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1063.05, "discounted_cash": 287.02, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK GUIDE 7 HOLE HEAD LFT FOR 2 COLUMN PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3.111.701", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1063.05, "discounted_cash": 287.02, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK GUIDE 7 HOLE HEAD RIGHT FOR 2 COLUMN PLATE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3.111.700", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1063.05, "discounted_cash": 287.02, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK ILIUM TRI-CORTICAL 3.0-3.9CM OSITB2039", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "OSITB2039", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4935.0, "discounted_cash": 1332.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK ILIUM TRI-CORTICAL 5.0+CM OSITB2041", "code_information": [{"code": "OSITB2041", "type": "CDM"}], "standard_charges": [{"gross_charge": 6735.0, "discounted_cash": 1818.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK INTRAMEDULLARY CONTOUR BOLT MAXIM", "code_information": [{"code": "32-348086", "type": "CDM"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 47.79, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION 3 DEGREE SLOTTED TIBL MAXIM", "code_information": [{"code": "32-347012", "type": "CDM"}], "standard_charges": [{"gross_charge": 2988.0, "discounted_cash": 806.76, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION ADJ LFT MICROPLASTY ELITE", "code_information": [{"code": "32-484552", "type": "CDM"}], "standard_charges": [{"gross_charge": 2868.0, "discounted_cash": 774.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION ADJ OPEN UNIVERSAL MICROPLASTY ELITE", "code_information": [{"code": "32-484553", "type": "CDM"}], "standard_charges": [{"gross_charge": 2868.0, "discounted_cash": 774.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION ADJ RIGHT MICROPLASTY ELITE", "code_information": [{"code": "32-484551", "type": "CDM"}], "standard_charges": [{"gross_charge": 2868.0, "discounted_cash": 774.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION ANT MAXIM", "code_information": [{"code": "32-347530", "type": "CDM"}], "standard_charges": [{"gross_charge": 1893.0, "discounted_cash": 511.11, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION DIST MAXIM", "code_information": [{"code": "32-347531", "type": "CDM"}], "standard_charges": [{"gross_charge": 10611.0, "discounted_cash": 2864.97, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION EXTRA SM 4IN 1 ASCENT", "code_information": [{"code": "32-379421", "type": "CDM"}], "standard_charges": [{"gross_charge": 7323.0, "discounted_cash": 1977.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION EXTRA XL 4IN 1 ASCENT", "code_information": [{"code": "32-379426", "type": "CDM"}], "standard_charges": [{"gross_charge": 7323.0, "discounted_cash": 1977.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION LG 4IN 1 ASCENT", "code_information": [{"code": "32-379424", "type": "CDM"}], "standard_charges": [{"gross_charge": 7323.0, "discounted_cash": 1977.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION MED 4IN 1 ASCENT", "code_information": [{"code": "32-379423", "type": "CDM"}], "standard_charges": [{"gross_charge": 7323.0, "discounted_cash": 1977.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION REV MAXIM", "code_information": [{"code": "32-347127", "type": "CDM"}], "standard_charges": [{"gross_charge": 5508.0, "discounted_cash": 1487.16, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION SM 4IN 1 ASCENT", "code_information": [{"code": "32-379422", "type": "CDM"}], "standard_charges": [{"gross_charge": 7323.0, "discounted_cash": 1977.21, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION TIBL 360 RESECTION BLOCK LFT VANGUARD", "code_information": [{"code": "32-487558", "type": "CDM"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION TIBL AUGMENT LFT VANGAURD 360", "code_information": [{"code": "32-360112", "type": "CDM"}], "standard_charges": [{"gross_charge": 4638.0, "discounted_cash": 1252.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION TIBL AUGMENT RIGHT VANGAURD 360", "code_information": [{"code": "32-360111", "type": "CDM"}], "standard_charges": [{"gross_charge": 4638.0, "discounted_cash": 1252.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION TIBLINTRAMEDULLARY VANGUARD 360", "code_information": [{"code": "32-422612", "type": "CDM"}], "standard_charges": [{"gross_charge": 4641.0, "discounted_cash": 1253.07, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTION UNIVERSAL CLOSED ADJ MICROPLASTY ELITE", "code_information": [{"code": "32-484554", "type": "CDM"}], "standard_charges": [{"gross_charge": 2868.0, "discounted_cash": 774.36, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK RESECTIONING TIBL 360 RESECTIONING BLOCK RIGHT VANGUARD", "code_information": [{"code": "32-487559", "type": "CDM"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SACROILIAC JOINT 27096", "code_information": [{"code": "27096", "type": "CPT"}, {"code": "1480201", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 4437.0, "discounted_cash": 1197.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOCK SAW SMALLL POST CUT OXFORD", "code_information": [{"code": "32-420325", "type": "CDM"}], "standard_charges": [{"gross_charge": 1986.0, "discounted_cash": 536.22, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SCREW 2.7MM FOR MODULAR GRAPHIC CASE SYS FOR SCREW MODULE SHELL", "code_information": [{"code": "60.116.059", "type": "CDM"}], "standard_charges": [{"gross_charge": 371.45, "discounted_cash": 100.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 55.0MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485200", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 57.5MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485201", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 60.0MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485202", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 62.5MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485203", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 65.0MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485204", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 67.5MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485205", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 70.0MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485206", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 72.5MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485209", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 75.0MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485207", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHELF 80.0MM ANT REFERENCING VANGUARD", "code_information": [{"code": "32-485208", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SHIFT ANT POST VANGUARD", "code_information": [{"code": "32-487070", "type": "CDM"}], "standard_charges": [{"gross_charge": 1356.0, "discounted_cash": 366.12, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SIDE MB AND J KNEE POSITIONER", "code_information": [{"code": "740012", "type": "CDM"}], "standard_charges": [{"gross_charge": 6369.0, "discounted_cash": 1719.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER 18.0MM VANGUARD", "code_information": [{"code": "32-488726", "type": "CDM"}], "standard_charges": [{"gross_charge": 1539.0, "discounted_cash": 415.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER 20.0MM VANGUARD", "code_information": [{"code": "32-488727", "type": "CDM"}], "standard_charges": [{"gross_charge": 1539.0, "discounted_cash": 415.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER 22.0MM VANGUARD", "code_information": [{"code": "32-488728", "type": "CDM"}], "standard_charges": [{"gross_charge": 1539.0, "discounted_cash": 415.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER 24.0MM VANGUARD", "code_information": [{"code": "32-488729", "type": "CDM"}], "standard_charges": [{"gross_charge": 1539.0, "discounted_cash": 415.53, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER 7 8 9MM VANG TENSOR", "code_information": [{"code": "32-468546", "type": "CDM"}], "standard_charges": [{"gross_charge": 2046.0, "discounted_cash": 552.42, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER SZ 10 AGC FLEXION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "32-467230", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 279.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER SZ 12 AGC FLEXION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "32-467232", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 279.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER SZ 14 AGC FLEXION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "32-467234", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 279.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER SZ 16 AGC FLEXION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "32-467236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 279.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER SZ 18 AGC FLEXION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "32-467238", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 279.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER SZ 20 AGC FLEXION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "32-467240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 279.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER SZ 22 AGC FLEXION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "32-467242", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 279.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER SZ 8 FLEX AGC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "32-467228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1035.0, "discounted_cash": 279.45, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER VANGUARD", "code_information": [{"code": "32-488721", "type": "CDM"}], "standard_charges": [{"gross_charge": 6972.0, "discounted_cash": 1882.44, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SPACER W/ RETAINING SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "510-08-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3679.5, "discounted_cash": 993.47, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK SURFACE TIBL RESECTION MAXIM", "code_information": [{"code": "32-347010", "type": "CDM"}], "standard_charges": [{"gross_charge": 2850.0, "discounted_cash": 769.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TENSOR 55.0MM VANG TENSOR AP BLOCK", "code_information": [{"code": "32-468560", "type": "CDM"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1158.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TENSOR 57.5MM VANG TENSOR AP BLOCK", "code_information": [{"code": "32-468561", "type": "CDM"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1158.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TENSOR 60.0MM VANG TENSOR AP BLOCK", "code_information": [{"code": "32-468562", "type": "CDM"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1158.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TENSOR 65.0MM VANG TENSOR AP BLOCK", "code_information": [{"code": "32-468564", "type": "CDM"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1158.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TENSOR 70.0MM VANG TENSOR AP BLOCK", "code_information": [{"code": "32-468566", "type": "CDM"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1158.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TENSOR 72.5MM VANG TENSOR AP BLOCK", "code_information": [{"code": "32-468569", "type": "CDM"}], "standard_charges": [{"gross_charge": 4290.0, "discounted_cash": 1158.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TENSOR VANG TENSOR DIST CUT BLOCK", "code_information": [{"code": "32-468544", "type": "CDM"}], "standard_charges": [{"gross_charge": 5520.0, "discounted_cash": 1490.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBIAL AUGMENTATION 71MM X 6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141743", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2907.0, "discounted_cash": 784.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 10MM X 63MM 67MM TRIAL UNIVERSAL OSS", "code_information": [{"code": "32-472062", "type": "CDM"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 440.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 10MM X 71/75MM UNIVERSAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "150427", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3021.0, "discounted_cash": 815.67, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 10MM X 71MM 75MM TRIAL UNIVERSAL OSS", "code_information": [{"code": "32-472063", "type": "CDM"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 440.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 10MM X 79MM 83MM TRIAL UNIVERSAL OSS", "code_information": [{"code": "32-472064", "type": "CDM"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 440.64, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 19MM TRIAL LL/RM", "code_information": [{"code": "32-341798", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 59MM TRIAL LL/RM", "code_information": [{"code": "32-341790", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 59MM TRIAL RL/LM", "code_information": [{"code": "32-341780", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 63MM TRIAL LL/RM", "code_information": [{"code": "32-341791", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 63MM TRIAL RL/LM", "code_information": [{"code": "32-341781", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 67MM TRIAL LL/RM", "code_information": [{"code": "32-341792", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 67MM TRIAL RL/LM", "code_information": [{"code": "32-341782", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 71MM TRIAL LL/RM", "code_information": [{"code": "32-341793", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 71MM TRIAL RL/LM", "code_information": [{"code": "32-341783", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 75MM TRIAL LL/RM", "code_information": [{"code": "32-341794", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 75MM TRIAL RL/LM", "code_information": [{"code": "32-341784", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 79MM TRIAL LL/RM", "code_information": [{"code": "32-341795", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 79MM TRIAL RL/LM", "code_information": [{"code": "32-341785", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 83MM TRIAL LL/RM", "code_information": [{"code": "32-341796", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 83MM TRIAL RL/LM", "code_information": [{"code": "32-341786", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 87MM TRIAL LL/RM", "code_information": [{"code": "32-341797", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 87MM TRIAL RL/LM", "code_information": [{"code": "32-341787", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 16MM X 91MM TRIAL RL/LM", "code_information": [{"code": "32-341788", "type": "CDM"}], "standard_charges": [{"gross_charge": 3366.0, "discounted_cash": 908.82, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 20MM X 63MM 67MM MEDIAL LFT LFT MEDIAL RIGHT LATERL OSS", "code_information": [{"code": "32-472066", "type": "CDM"}], "standard_charges": [{"gross_charge": 2676.0, "discounted_cash": 722.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 20MM X 63MM 67MM TRIAL MEDIAL RIGHT LAT LFT OSS", "code_information": [{"code": "32-472065", "type": "CDM"}], "standard_charges": [{"gross_charge": 2676.0, "discounted_cash": 722.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 20MM X 71MM 75MM LFT MEDIAL RIGHT LAT TRIAL OSS", "code_information": [{"code": "32-472068", "type": "CDM"}], "standard_charges": [{"gross_charge": 2676.0, "discounted_cash": 722.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 20MM X 71MM 75MM TRIAL RIGHT MEDIAL LFT LAT OSS", "code_information": [{"code": "32-472067", "type": "CDM"}], "standard_charges": [{"gross_charge": 2676.0, "discounted_cash": 722.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 20MM X 79MM 83MM LFT MEDIAL RIGHT LAT TRIAL OSS", "code_information": [{"code": "32-472070", "type": "CDM"}], "standard_charges": [{"gross_charge": 2676.0, "discounted_cash": 722.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 20MM X 79MM 83MM RIGHT MEDIAL LFT LAT TRIAL OSS", "code_information": [{"code": "32-472069", "type": "CDM"}], "standard_charges": [{"gross_charge": 2676.0, "discounted_cash": 722.52, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 59MM X 10MM TRIAL", "code_information": [{"code": "32-341760", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 59MM X 6MM TRIAL", "code_information": [{"code": "32-341740", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 63MM X 10MM TRIAL", "code_information": [{"code": "32-341761", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 63MM X 6MM TRIAL", "code_information": [{"code": "32-341741", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 67MM X 10MM TRIAL", "code_information": [{"code": "32-341762", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 67MM X 6MM TRIAL", "code_information": [{"code": "32-341742", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 71MM X 10MM TRIAL", "code_information": [{"code": "32-341763", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 71MM X 6MM TRIAL", "code_information": [{"code": "32-341743", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 75MM X 10MM TRIAL", "code_information": [{"code": "32-341764", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 75MM X 6MM AUGMENTATION ASCENT MAXIM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "141744", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2907.0, "discounted_cash": 784.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 75MM X 6MM TRIAL", "code_information": [{"code": "32-341744", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 79MM X 10MM TRIAL", "code_information": [{"code": "32-341765", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 79MM X 6MM TRIAL", "code_information": [{"code": "32-341745", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 83MM X 10MM TRIAL", "code_information": [{"code": "32-341766", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 83MM X 6MM TRIAL", "code_information": [{"code": "32-341746", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 87MM X 10MM TRIAL", "code_information": [{"code": "32-341767", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 87MM X 6MM TRIAL", "code_information": [{"code": "32-341747", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 91MM X 10MM TRIAL", "code_information": [{"code": "32-341768", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL 91MM X 6MM TRIAL", "code_information": [{"code": "32-341748", "type": "CDM"}], "standard_charges": [{"gross_charge": 1515.0, "discounted_cash": 409.05, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL FIXED DIST CUT MICROPLASTY", "code_information": [{"code": "32-485001", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL LFT MP ELITE SLIDEX", "code_information": [{"code": "32-484585", "type": "CDM"}], "standard_charges": [{"gross_charge": 2952.0, "discounted_cash": 797.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL RESECTION CUT LFT MICROPLASTY", "code_information": [{"code": "32-485556", "type": "CDM"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL RESECTION CUT RIGHT MICROPLASTY", "code_information": [{"code": "32-485557", "type": "CDM"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL RESECTION GUIDE MAXIM", "code_information": [{"code": "32-348050", "type": "CDM"}], "standard_charges": [{"gross_charge": 3138.0, "discounted_cash": 847.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL RIGHT MP ELITE SLIDEX", "code_information": [{"code": "32-484586", "type": "CDM"}], "standard_charges": [{"gross_charge": 2952.0, "discounted_cash": 797.04, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCK TIBL SLIDING DIST CUT MICROPLASTY", "code_information": [{"code": "32-485000", "type": "CDM"}], "standard_charges": [{"gross_charge": 6960.0, "discounted_cash": 1879.2, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCKINTRAMEDULLARY 60MM CONTRAINED CONTOUR MAXIM", "code_information": [{"code": "32-348081", "type": "CDM"}], "standard_charges": [{"gross_charge": 5469.0, "discounted_cash": 1476.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCKINTRAMEDULLARY 65MM CONTRAINED CONTOUR MAXIM", "code_information": [{"code": "32-348082", "type": "CDM"}], "standard_charges": [{"gross_charge": 5469.0, "discounted_cash": 1476.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCKINTRAMEDULLARY 70MM CONSTRAINED CONTOUR MAXIM", "code_information": [{"code": "32-348083", "type": "CDM"}], "standard_charges": [{"gross_charge": 5469.0, "discounted_cash": 1476.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOCKINTRAMEDULLARY 75MM CONTRAINED CONTOUR MAXIM", "code_information": [{"code": "32-348084", "type": "CDM"}], "standard_charges": [{"gross_charge": 5469.0, "discounted_cash": 1476.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BLOOC CLOT FACTOR V TEST", "code_information": [{"code": "85220", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 15.89, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT LYSIS TIME", "code_information": [{"code": "85175", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 18.33, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CLOT RETRACTION", "code_information": [{"code": "85170", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 14.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD CULTURE FOR BACTERIA", "code_information": [{"code": "87040", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 9.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD FUNGUS CULTURE", "code_information": [{"code": "87103", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 18.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES O2 SAT ONLY", "code_information": [{"code": "82810", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 8.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD GASES W/O2 SATURATION", "code_information": [{"code": "82805", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 70.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD MUCOPROTEIN", "code_information": [{"code": "P2038", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.46, "maximum": 4.46, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PH", "code_information": [{"code": "82800", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 9.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PLATELET AGGREGATION", "code_information": [{"code": "85576", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 22.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD PRODUCT/IRRADIATION", "code_information": [{"code": "86945", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 30.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD SMEAR INTERPRETATION", "code_information": [{"code": "85060", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 22.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD THYMOL TURBIDITY", "code_information": [{"code": "P2033", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.46, "maximum": 4.46, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPE ANTIGEN DONOR EA", "code_information": [{"code": "86902", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING ANTIGEN SYSTEM", "code_information": [{"code": "86911", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 20.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD TYPING PATERNITY TEST", "code_information": [{"code": "86910", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 23.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD VISCOSITY EXAMINATION", "code_information": [{"code": "85810", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOOD VOLUME", "code_information": [{"code": "78122", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 139.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLOODPRESSURE CHILD 1 TUBE", "code_information": [{"code": "MDS9911HP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.05, "discounted_cash": 1.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUE LIGHT CYSTO IMAG AGENT", "code_information": [{"code": "C9738", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BLUECATH 22G BLUE AUTOGUARD B-D382523Z", "code_information": [{"code": "B-D382523Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.99, "discounted_cash": 2.43, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUNT PIN 3.2 MM 500374", "code_information": [{"code": "500374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 37.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUNT SELF TAPPING APEX HALF PINS, 2MM X 36MM", "code_information": [{"code": "5065-3-615", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 261.26, "discounted_cash": 70.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BLUNT TIP SEALER REPROCESSED LIGASURE/DIVIDER NANO-COATED LF1837CRH", "code_information": [{"code": "LF1837CRH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": 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"discounted_cash": 469.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT TROCHANTERIC 44MM MODULAR FEMORAL REV SYS LAT ARCOS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-302144", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1740.0, "discounted_cash": 469.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT TROCHANTERIC 45MM MODULAR FEMORAL REV SYS LAT ARCOS", "code_information": [{"code": "11-302145", "type": "CDM"}], "standard_charges": [{"gross_charge": 1740.0, "discounted_cash": 469.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT TROCHANTERIC 46MM MODULAR FEMORAL REV SYS LAT ARCOS", "code_information": [{"code": "11-302146", "type": "CDM"}], "standard_charges": [{"gross_charge": 1740.0, "discounted_cash": 469.8, "setting": "both", "billing_class": "facility"}]}, {"description": "BOLT TROCHANTERIC 47MM MODULAR FEMORAL REV SYS LAT ARCOS", 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"setting": "both", "billing_class": "facility"}]}, {"description": "BONE CANCELLOUS CUBES 5CC PARAMETRIC", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "OSCB2006-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 99.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CEMENT SMARTSET MV 3122-040", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "3122-040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 144.0, "discounted_cash": 38.88, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE CEMENT VERTIFIX HV W/BARIUM G90005", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "G90005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE COMPRESSION 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING RAMUS CLOSED", "code_information": [{"code": "D7941", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE CUTTING SEGMENTED", "code_information": [{"code": "D7944", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": 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HARVISTORY FENSTRATION PERFORATOR 12MM P99-100-2010", "code_information": [{"code": "P99-100-2010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 664.95, "discounted_cash": 179.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GRAFT MATRIX SUBSTITUTE MEDIUM 6.25CC 5CM 74000063", "code_information": [{"code": "C9399", "type": "HCPCS"}, {"code": "74000063", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 4890.0, "discounted_cash": 1320.3, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GUIDE MED PARTIAL KNEE ARTHROPLASTY SIGNATURE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-411562", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5325.0, "discounted_cash": 1437.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE GUIDE TOTAL KNEE ARTHROPLASTY MODEL SET 03 02 SIGNATURE", 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"standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 654.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW ASPIRATION ONLY 38220", "code_information": [{"code": "38220", "type": "CPT"}, {"code": "1643980", "type": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 1377.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW BIOPSY; NEEDLE OR TROCAR 38221", "code_information": [{"code": "38221", "type": "CPT"}, {"code": "43040996", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1848.0, "discounted_cash": 498.96, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 1386.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW HARVEST AUTOLOG", "code_information": [{"code": "38232", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW IMAGING BODY", "code_information": [{"code": "78104", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 298.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MARROW INTERPRETATION", "code_information": [{"code": "85097", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 590.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MATRIX ALLOSYNC PURE 1.0CC", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "ABS-2010-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE MINERAL DUAL PHOTON", "code_information": [{"code": "78351", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 24.52, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 15.8, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE MINERAL SINGLE PHOTON", "code_information": [{"code": "78350", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 32.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BONE PATELLA 10MM WEDGE FREEZE DRIED STRL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "6204618", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3585.0, "discounted_cash": 967.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PILOT 13.0MM COMPRESS", "code_information": [{"code": "32-481090", "type": "CDM"}], "standard_charges": [{"gross_charge": 951.0, "discounted_cash": 256.77, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY STIMUBLAST DBM 1CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2001-01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE PUTTY STIMUBLAST DBM 2.5CC", "code_information": [{"code": "C9359", "type": "HCPCS"}, {"code": "ABS-2001-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1320.0, "discounted_cash": 356.4, "setting": "both", "billing_class": 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[{"code": "C1713", "type": "HCPCS"}, {"code": "657448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 103.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 35MM CORTICAL LOCK TTL WRIST 8WC4-1035-A", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8WC4-1035-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 654.0, "discounted_cash": 176.58, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW 5.0MM X 32.0MM W/ T25 SRATDRIVE RECESS SLF TAP LCKNG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "212.21", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 549.0, "discounted_cash": 148.23, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T6 2.0MM L24MM-657724", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657724", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 243.0, "discounted_cash": 65.61, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T6 2.0MM L26MM-657726", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "657726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 96.39, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T8 2.7MM L48MM 656448", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656448", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 99.63, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T8 2.7MM L55MM 656455", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656455", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 247.68, "discounted_cash": 66.87, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T8 FULL THREAD 2.4MM/L18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 333.0, "discounted_cash": 89.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SCREW T8 FULL THREAD 2.7MM/L36MM 656436", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "656436", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 333.0, "discounted_cash": 89.91, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE STAPLE COMPRESSION SYSTEM DYNAMIC EASY FUSE 20 X 20MM FFS22020", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FFS22020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4929.0, "discounted_cash": 1330.83, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE SUBSTITUTE DELIVERY CANNULA INJECTABLE  4000050", "code_information": [{"code": "4000050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.0, "discounted_cash": 222.75, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE VOID FILLER 10ML CERAMENT A0210-08", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "A0210-08", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8085.0, "discounted_cash": 2182.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE VOID FILLER 5 CC CALLOS IMPACT", "code_information": [{"code": "65-0005-S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4659.0, "discounted_cash": 1257.93, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE VOID FILLER ARTHREX CALCIUM SULFATE BIOBEADS 10CC ABS-3000-10", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "ABS-3000-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3900.0, "discounted_cash": 1053.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WAX  LUKENS 901", "code_information": [{"code": "901", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.2, "discounted_cash": 5.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WAX DYNJBW25", "code_information": [{"code": "DYNJBW25", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.76, "discounted_cash": 5.34, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WEDGE 12MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MWEV0012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WEDGE 8MM EVANS  MWEV0008", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "MWEV0008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE WEDGE PRE HYDRATED EVANS 6MM MWEV0006", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "MWEV0006", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BONE/SKIN GRAFT GREAT TOE", "code_information": [{"code": "20973", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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[{"gross_charge": 148.8, "discounted_cash": 40.18, "setting": "both", "billing_class": "facility"}]}, {"description": "BOOT WALKER XL", "code_information": [{"code": "1067769-06", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 37.26, "setting": "both", "billing_class": "facility"}]}, {"description": "BOOTIES YELLOW VASCULAR  DYNJSBY5H", "code_information": [{"code": "DYNJSBY5H", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.33, "discounted_cash": 1.71, "setting": "both", "billing_class": "facility"}]}, {"description": "BORDETELLA ANTIBODY", "code_information": [{"code": "86615", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE COMPLEX", "code_information": [{"code": "77318", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE INTERMED", "code_information": [{"code": "77317", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRACHYTX ISODOSE PLAN SIMPLE", "code_information": [{"code": "77316", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAF GENE", "code_information": [{"code": "81210", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR COMPLX", "code_information": [{"code": "61698", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN ANEURYSM REPR SIMPLE", "code_information": [{"code": "61700", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN BIOPSY W/CT/MR GUIDE", "code_information": [{"code": "61751", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN CAVITY SHUNT W/SCOPE", "code_information": [{"code": "62201", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN FLOW IMAGING ONLY", "code_information": [{"code": "78610", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 230.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE 4+ VIEWS", "code_information": [{"code": "78605", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 239.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE < 4 VIEWS", "code_information": [{"code": "78600", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 220.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW 4 + VIEWS", "code_information": [{"code": "78606", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 404.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGE W/FLOW < 4 VIEWS", "code_information": [{"code": "78601", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 262.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78608", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1406.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAIN IMAGING (PET)", "code_information": [{"code": "78609", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 121.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRAVO CAPSULE GASTRIC REFLUX", "code_information": [{"code": "FGS-0635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1087.68, "discounted_cash": 293.67, "setting": "both", "billing_class": "facility"}]}, {"description": "BRAVO PH RECORDER STRAP", "code_information": [{"code": "FGS-0516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.45, "discounted_cash": 13.08, "setting": "both", "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81166", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 271.22, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE FULL SEQ ALYS", "code_information": [{"code": "81165", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81215", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 185&5385&6174 VRNT", "code_information": [{"code": "81212", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 396.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FUL DUP/DEL ALYS", "code_information": [{"code": "81164", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 525.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GEN FULL SEQ DUP/DEL", "code_information": [{"code": "81162", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1642.39, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA1&2 GENE FULL SEQ ALYS", "code_information": [{"code": "81163", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 421.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL DUP/DEL ALYS", "code_information": [{"code": "81167", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 254.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE FULL SEQ ALYS", "code_information": [{"code": "81216", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 166.61, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRCA2 GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81217", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 337.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAKER TAPER OSS", "code_information": [{"code": "32-481160", "type": "CDM"}], "standard_charges": [{"gross_charge": 20343.0, "discounted_cash": 5492.61, "setting": "both", "billing_class": "facility"}]}, {"description": "BREAST \"\"STACKED\"\" DIEP/GAP", "code_information": [{"code": "S2067", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST BIOPSY NEEDLE LOCALIZATION 19125", "code_information": [{"code": "19125", "type": "CPT"}, {"code": "1480204", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6585.0, "gross_charge": 8780.0, "discounted_cash": 2370.6, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6585.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST DIEP OR SIEA FLAP", "code_information": [{"code": "S2068", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST GAP FLAP RECONST", "code_information": [{"code": "S2066", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST RECON W/TRANSERSE RECTUS ABD MYO FLAP  TRAM SINGLE PED. W/CLOSURE 19367", "code_information": [{"code": "19367", "type": "CPT"}, {"code": "1792993", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6477.75, "gross_charge": 8637.0, "discounted_cash": 2331.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6477.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77062", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 119.97, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS BI", "code_information": [{"code": "77063", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 25.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREAST TOMOSYNTHESIS UNI", "code_information": [{"code": "77061", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 94.11, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH HYDROGEN/METHANE TEST", "code_information": [{"code": "91065", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH RECORDING INFANT", "code_information": [{"code": "94772", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BREATH TEST ANALYSIS C-14", "code_information": [{"code": "78268", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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"standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 18.35, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 11.72, "methodology": "fee schedule"}], 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"facility"}]}, {"description": "BRIDGE PRIMARY 10MM X 63MM TO 67MM LIPPED TRIAL MAXIM", "code_information": [{"code": "32-346330", "type": "CDM"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 109.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE PRIMARY 10MM X 71MM TO 75MM LIPPED TRIAL", "code_information": [{"code": "32-346350", "type": "CDM"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE PRIMARY 10MM X 79MM TO 83MM BROWN TRIAL MAXIM", "code_information": [{"code": "32-341940", "type": "CDM"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE PRIMARY 10MM X 79MM TO 83MM LIPPED TRIAL MAXIM", "code_information": [{"code": "32-346370", "type": "CDM"}], "standard_charges": [{"gross_charge": 456.0, "discounted_cash": 123.12, "setting": "both", 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"discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE PRIMARY 14MM X 63MM TO 67MM GRN TRIAL MAXIM", "code_information": [{"code": "32-341924", "type": "CDM"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE PRIMARY 14MM X 63MM TO 67MM LIPPED TRIAL MAXIM", "code_information": [{"code": "32-346334", "type": "CDM"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 109.35, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE PRIMARY 14MM X 71MM TO 75MM GRAY TRIAL MAXIM", "code_information": [{"code": "32-341934", "type": "CDM"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE PRIMARY 14MM X 71MM TO 75MM LIPPED TRIAL MAXIM", "code_information": [{"code": "32-346354", "type": "CDM"}], "standard_charges": 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{"description": "BRIDGE TIBL 10MM X 63MM TO 67MM GRN TRIAL RADEL MAXIM", "code_information": [{"code": "32-343130", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 10MM X 71MM 75MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470322", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 10MM X 71MM TO 75MM GRAY TRIALING RADEL MAXIM", "code_information": [{"code": "32-343150", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 10MM X 79MM TO 83MM BROWN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343170", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": 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129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 12MM X 63MM 67MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470313", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 12MM X 63MM TO 67MM GRN TRIAL RADEL MAXIM", "code_information": [{"code": "32-343132", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 12MM X 71MM 75MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470323", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 12MM X 71MM TO 75 M GRAY TRIALING RADEL MAXIM", "code_information": [{"code": "32-343152", "type": "CDM"}], "standard_charges": 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"type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 14MM 63MM 67MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470314", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 14MM X 59MM TRIAL RUST RADEL MAXIM", "code_information": [{"code": "32-343114", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 14MM X 59MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470304", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 14MM X 63MM TO 67MM GRN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343134", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 14MM X 71MM 75MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470324", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 14MM X 71MM TO 75MM GRAY TRIALING RADEL MAXIM", "code_information": [{"code": "32-343154", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 14MM X 79MM 83MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470334", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 14MM X 79MM TO 83MM BROWN 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{"description": "BRIDGE TIBL 16MM X 71MM TO 75MM GRAY TRIALING RADEL MAXIM", "code_information": [{"code": "32-343156", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 16MM X 79MM 83MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470335", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 16MM X 79MM TO 83MM BROWN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343176", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 16MM X 87MM 91MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470345", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 16MM X 87MM TO 91MM TEAL TRIAL RADEL MAXIM", "code_information": [{"code": "32-343196", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM 71MM 75MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470326", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 59MM TRIAL RUST RADEL MAXIM", "code_information": [{"code": "32-343118", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 59MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470306", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 63MM 67MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470316", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 63MM TO 67MM GRN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343138", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 71MM TO 75MM GRAY TRIALING RADEL MAXIM", "code_information": [{"code": "32-343158", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 79MM 83MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470336", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 79MM TO 83MM BROWN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343178", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 87MM 91MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470346", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 18MM X 87MM TO 91MM TEAL TRIAL RADEL MAXIM", "code_information": [{"code": "32-343198", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM 63MM 67MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470317", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 59MM TRIAL RUST RADEL MAXIM", "code_information": [{"code": "32-343120", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 59MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470307", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 63MM TO 67MM GRN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343140", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 71MM 75MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470327", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 71MM TO 75MM GRAY TRIALING RADEL MAXIM", "code_information": [{"code": "32-343160", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 79MM 83MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470337", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 79MM TO 83MM BROWN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343180", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 87MM 91MM TRIAL TRADITION PRIMARY AGC", "code_information": [{"code": "32-470340", "type": "CDM"}], "standard_charges": [{"gross_charge": 480.0, "discounted_cash": 129.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 20MM X 87MM TO 91MM TEAL TRIAL RADEL MAXIM", "code_information": [{"code": "32-343200", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 22MM X 63MM TO 67MM GRN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343142", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 22MM X 71MM TO 75MM GRAY TRIALING RADEL MAXIM", "code_information": [{"code": "32-343162", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 22MM X 79MM TO 83MM BROWN TRIAL RADEL MAXIM", "code_information": [{"code": "32-343182", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 22MM X 87MM TO 91MM TEAL TRIAL RADEL MAXIM", "code_information": [{"code": "32-343202", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 24MM TO 63MM TO 67MM GRN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343144", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 24MM X 71MM TO 75MM GRAY TRIALING RADEL MAXIM", "code_information": [{"code": "32-343164", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 24MM X 79MM TO 83MM BROWN TRIALING RADEL MAXIM", "code_information": [{"code": "32-343184", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIDGE TIBL 24MM X 87MM TO 91MM TEAL TRIAL RADEL MAXIM", "code_information": [{"code": "32-343204", "type": "CDM"}], "standard_charges": [{"gross_charge": 507.0, "discounted_cash": 136.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BRIEF EMOTIONAL/BEHAV ASSMT", "code_information": [{"code": "96127", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC RF DSTRJ PULM NRV BI", "code_information": [{"code": "781T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR 1ST", "code_information": [{"code": "31645", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRNCHSC W/THER ASPIR SBSQ", "code_information": [{"code": "31646", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"discounted_cash": 1085.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH FRACTURE 14MM HIP", "code_information": [{"code": "31-473903", "type": "CDM"}], "standard_charges": [{"gross_charge": 4020.0, "discounted_cash": 1085.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH FRACTURE 16MM HIP", "code_information": [{"code": "31-473904", "type": "CDM"}], "standard_charges": [{"gross_charge": 4020.0, "discounted_cash": 1085.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH FRACTURE 18MM HIP", "code_information": [{"code": "31-473905", "type": "CDM"}], "standard_charges": [{"gross_charge": 4020.0, "discounted_cash": 1085.4, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH FULL TOOTH 10MM EXACT ALLIANCE", "code_information": [{"code": "31-480010", "type": "CDM"}], "standard_charges": [{"gross_charge": 3975.0, "discounted_cash": 1073.25, "setting": "both", "billing_class": 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"type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 13MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200262", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 14MM X 80MM LFT BALANCE", "code_information": [{"code": "31-200265", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 14MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200264", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 15MM X 80MM LFT BALANCE", "code_information": [{"code": "31-200267", "type": 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"standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 17MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200270", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 18MM X 80MM LFT BALANCE", "code_information": [{"code": "31-200273", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 18MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200272", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 19MM X 80MM LFT BALANCE", "code_information": [{"code": "31-200275", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 19MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200274", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 20MM X 80MM LFT BALANCE", "code_information": [{"code": "31-200277", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 20MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200276", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 7MM X 80MM LFT BALANCE", "code_information": [{"code": "31-200251", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 7MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200250", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 8MM X 80MM LFT BALANCE", "code_information": [{"code": "31-200253", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 8MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200252", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 9MM X 80MM LFT BALANCE", "code_information": [{"code": "31-200255", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH MICROPLASTY 9MM X 80MM RIGHT BALANCE", "code_information": [{"code": "31-200254", "type": "CDM"}], "standard_charges": [{"gross_charge": 3075.0, "discounted_cash": 830.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH TIBL EXTRA SM 25.0MM TRIAL REGENEREX", "code_information": [{"code": "32-484601", "type": "CDM"}], "standard_charges": [{"gross_charge": 5475.0, "discounted_cash": 1478.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH TIBL EXTRA SM 40.0MM TRIAL REGENEREX", "code_information": [{"code": "32-484605", "type": "CDM"}], "standard_charges": [{"gross_charge": 5475.0, "discounted_cash": 1478.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH TIBL LG 25.0MM TRIAL REGENEREX", "code_information": [{"code": "32-484604", "type": "CDM"}], "standard_charges": [{"gross_charge": 5475.0, "discounted_cash": 1478.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH TIBL LG 40.0MM TRIAL REGENEREX", "code_information": [{"code": "32-484608", "type": "CDM"}], "standard_charges": [{"gross_charge": 5475.0, "discounted_cash": 1478.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH TIBL MED 25.0MM TRIAL REGENEREX", "code_information": [{"code": "32-484603", "type": "CDM"}], "standard_charges": [{"gross_charge": 5475.0, "discounted_cash": 1478.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH TIBL MED 40.0MM TRIAL REGENEREX", "code_information": [{"code": "32-484607", "type": "CDM"}], "standard_charges": [{"gross_charge": 5475.0, "discounted_cash": 1478.25, "setting": "both", "billing_class": "facility"}]}, {"description": "BROACH TIBL SM 25.0MM TRIAL REGENEREX", "code_information": [{"code": "32-484602", "type": "CDM"}], "standard_charges": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 1/2 NODE", "code_information": [{"code": "31652", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH EBUS SAMPLNG 3/> NODE", "code_information": [{"code": "31653", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH LAVAGE W/EBUS", "code_information": [{"code": "C7556", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 4876.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "BRONCH THERMOPLSTY 1 LOBE", "code_information": [{"code": "31660", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCH/BPSY(S) W/ NAVIGATION", "code_information": [{"code": "C7511", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": 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"AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], 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"plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE ADDL INSERT", "code_information": [{"code": "31651", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE INIT INSERT", "code_information": [{"code": "31647", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV ADDL", "code_information": [{"code": "31649", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHIAL VALVE REMOV INIT", "code_information": [{"code": "31648", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPE ASCOPE 4 REGULAR 477101000", "code_information": [{"code": "477101000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 656.7, "discounted_cash": 177.31, "setting": "both", "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY BRONCH STENTS", "code_information": [{"code": "31636", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY DILATE W/STENT", "code_information": [{"code": "31631", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/BIOPSY(S)", "code_information": [{"code": "31625", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY W/MARKERS", "code_information": [{"code": "31626", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BRONCHOSCOPY/LUNG BX EACH", "code_information": [{"code": "31628", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"billing_class": "facility"}]}, {"description": "BUSHING TIBL 7.5MM 360 DEGREE REAMER VANGAURD", "code_information": [{"code": "32-360088", "type": "CDM"}], "standard_charges": [{"gross_charge": 1302.0, "discounted_cash": 351.54, "setting": "both", "billing_class": "facility"}]}, {"description": "BUSHING TIBL POLY IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "150476", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 807.0, "discounted_cash": 217.89, "setting": "both", "billing_class": "facility"}]}, {"description": "BUSHING WIRE 3.2MM", "code_information": [{"code": "14-440046", "type": "CDM"}], "standard_charges": [{"gross_charge": 1218.0, "discounted_cash": 328.86, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTORPHANOL (STADOL) INJ 1MG/ML 1 ML", "code_information": [{"code": "MED0049", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 17.03, "discounted_cash": 4.6, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTOCK FASCIOTOMY", "code_information": [{"code": "27027", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, 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"code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8922", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 81.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON SUT DOG BONE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2270", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE 144MM ROUND ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 695.94, "discounted_cash": 187.9, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE 8MM X 12MM ABS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.03, "discounted_cash": 125.56, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 11MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-3", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 728.46, "discounted_cash": 196.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 12MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-5", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 728.46, "discounted_cash": 196.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON TIGHTROPE ABS 14MM ROUND CONCAVE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1588TB-4", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 728.46, "discounted_cash": 196.68, "setting": "both", "billing_class": "facility"}]}, {"description": "BUTTON XTENDO ROUND SMALL 15MM DIA 71935601", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71935601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 157.95, "setting": "both", "billing_class": "facility"}]}, {"description": "BX BREAST 1ST LESION MR IMAG", "code_information": [{"code": "19085", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST ADD LESION US 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX BREAST PERCUT W/O IMAGE", "code_information": [{"code": "19100", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN CRVL", "code_information": [{"code": "63275", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "BX/EXC XDRL SPINE LESN THRC", "code_information": [{"code": "63276", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, 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3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL SINGLE", "code_information": [{"code": "33533", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL THREE", "code_information": [{"code": "33535", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERIAL TWO", "code_information": [{"code": "33534", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FIVE", "code_information": [{"code": "33522", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN FOUR", "code_information": [{"code": "33521", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN THREE", "code_information": [{"code": "33519", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG ARTERY-VEIN TWO", "code_information": [{"code": "33518", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FIVE", "code_information": [{"code": "33514", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN FOUR", "code_information": [{"code": "33513", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SINGLE", "code_information": [{"code": "33510", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN SIX OR MORE", "code_information": [{"code": "33516", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN THREE", "code_information": [{"code": "33512", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABG VEIN TWO", "code_information": [{"code": "33511", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CABLE 1.5MM POLYMER W/ TI CLASP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "35-100-1010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1470.0, "discounted_cash": 396.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE BEADED 1.6MM VITALLIUM DALL-MILES", "code_information": [{"code": "6704-8-236", "type": "CDM"}], "standard_charges": [{"gross_charge": 829.5, "discounted_cash": 223.97, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE BEADED 2.0MM VITALLIUM DALL-MILES", "code_information": [{"code": "6704-8-240", "type": "CDM"}], "standard_charges": [{"gross_charge": 829.5, "discounted_cash": 223.97, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE BMP SENSOR TYPE II", "code_information": [{"code": "498007", "type": "CDM"}], "standard_charges": [{"gross_charge": 11925.0, "discounted_cash": 3219.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE CERCLAGE 1MM X 750MM W/ CRIMP SS STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "298.800.01S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1739.25, "discounted_cash": 469.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE COBALT CHROME 1.7MM 750MM W/ TI CRIMP STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "611.105.01S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1741.5, "discounted_cash": 470.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CABLE CONNECTING FOR HNS 11 F STIMUPLEX", 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ACOUS WAVFRM REC CAD RSK", "code_information": [{"code": "716T", "type": "CPT"}], "standard_charges": [{"minimum": 1589.0, "maximum": 1589.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 10 GNS", "code_information": [{"code": "81413", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR ION CHNNLPATH INC 2 GNS", "code_information": [{"code": "81414", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 526.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR OUTP MEAS DRG CATH CHD", "code_information": [{"code": "93598", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-CAR BP GRFT/ENDOVAS TAA", "code_information": [{"code": "33891", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CAR-T CLL ADMN AUTOLOGOUS", "code_information": [{"code": "540T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 1810.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "CARBACHOL OPTHALMIC 0.01% (MIOSTAT) 1.5ML", "code_information": [{"code": "MED0052", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 53.81, "discounted_cash": 14.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBON CONNECTING RODS, 3 MM X 90MM", "code_information": [{"code": "5079-6-090", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.7, "discounted_cash": 67.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBON CONNECTING RODS, 3MM X 120MM", "code_information": [{"code": "5079-6-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 249.7, "discounted_cash": 67.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CARBON ROD 11 X 200MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4922-8-200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1119.72, "discounted_cash": 302.32, "setting": "both", "billing_class": "facility"}]}, {"description": "CARCINOEMBRYONIC ANTIGEN", "code_information": [{"code": "82378", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 17.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARD HOLDER OER-PRO", "code_information": [{"code": "GT271000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.42, "discounted_cash": 6.59, "setting": "both", "billing_class": "facility"}]}, {"description": "CARD MRI VELOC FLOW MAPPING", "code_information": [{"code": "75565", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 121.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARD MRI W/STRESS IMG & DYE", "code_information": [{"code": "75563", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 806.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 785.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC DRUG STRESS TEST", "code_information": [{"code": "93024", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH", "code_information": [{"code": "75557", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 496.29, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI FOR MORPH W/DYE", "code_information": [{"code": "75561", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 718.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRAIN", "code_information": [{"code": "C9762", "type": "HCPCS"}], "standard_charges": [{"minimum": 533.32, "maximum": 1624.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 533.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI SEG DYS STRESS", "code_information": [{"code": "C9763", "type": "HCPCS"}], "standard_charges": [{"minimum": 533.32, "maximum": 1624.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 533.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC MRI W/STRESS IMG", "code_information": [{"code": "75559", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 526.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 533.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB", "code_information": [{"code": "93797", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC REHAB/MONITOR", "code_information": [{"code": "93798", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CARDIAC SHUNT IMAGING", "code_information": [{"code": "78428", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 224.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent 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"code_information": [{"code": "596000", "type": "CDM"}], "standard_charges": [{"gross_charge": 23118.0, "discounted_cash": 6241.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR SERIES 1 PATELLA MILL", "code_information": [{"code": "595138", "type": "CDM"}], "standard_charges": [{"gross_charge": 7878.0, "discounted_cash": 2127.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR SHELLGA REAMER RINGLOC", "code_information": [{"code": "595621", "type": "CDM"}], "standard_charges": [{"gross_charge": 5277.0, "discounted_cash": 1424.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR SHOULER RETRACTOR COMP", "code_information": [{"code": "595505", "type": "CDM"}], "standard_charges": [{"gross_charge": 6987.0, "discounted_cash": 1886.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR SM OXFORD FEMORAL", "code_information": [{"code": "595179", "type": "CDM"}], "standard_charges": [{"gross_charge": 8277.0, "discounted_cash": 2234.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR SURFACE FEMORAL BLOCK CUT VANGUARD", "code_information": [{"code": "596702", "type": "CDM"}], "standard_charges": [{"gross_charge": 6507.0, "discounted_cash": 1756.89, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR TENSOR VANGUARD", "code_information": [{"code": "596701", "type": "CDM"}], "standard_charges": [{"gross_charge": 5880.0, "discounted_cash": 1587.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR TIBL AUGMENTED TRIAL VANGUARD", "code_information": [{"code": "595310", "type": "CDM"}], "standard_charges": [{"gross_charge": 9180.0, "discounted_cash": 2478.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR TIBL MP VANGUARD", "code_information": [{"code": "595303", "type": "CDM"}], "standard_charges": [{"gross_charge": 6579.0, "discounted_cash": 1776.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR TIBL PROVISIONAL OSS REDUCED SZ", "code_information": [{"code": "595108", "type": "CDM"}], "standard_charges": [{"gross_charge": 14886.0, "discounted_cash": 4019.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR TOPINSERT COPELAND", "code_information": [{"code": "595212", "type": "CDM"}], "standard_charges": [{"gross_charge": 4338.0, "discounted_cash": 1171.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR TOTAL WRIST SYS MAESTRO", "code_information": [{"code": "595222", "type": "CDM"}], "standard_charges": [{"gross_charge": 7563.0, "discounted_cash": 2042.01, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR TRIAL GLEN", "code_information": [{"code": "595167", "type": "CDM"}], "standard_charges": [{"gross_charge": 5277.0, "discounted_cash": 1424.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR UNIVERSAL BEARING 5IN 1 VANGUARD", "code_information": [{"code": "595338", "type": "CDM"}], "standard_charges": [{"gross_charge": 10770.0, "discounted_cash": 2907.9, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR UNIVERSAL BEARING CR VANGUARD", "code_information": [{"code": "595337", "type": "CDM"}], "standard_charges": [{"gross_charge": 6579.0, "discounted_cash": 1776.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTR XL OXFORD FEMORAL", "code_information": [{"code": "595182", "type": "CDM"}], "standard_charges": [{"gross_charge": 8277.0, "discounted_cash": 2234.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTRINSERTION AND SCREW RINGLOC", "code_information": [{"code": "595620", "type": "CDM"}], "standard_charges": [{"gross_charge": 7878.0, "discounted_cash": 2127.06, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINSTRINSERTION EXTRACTION PROVISIONAL HEAD NECK ALLIANCE", "code_information": [{"code": "595551", "type": "CDM"}], "standard_charges": [{"gross_charge": 9180.0, "discounted_cash": 2478.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CASEINTRUMENT TRAY 1 ECHO REAMER", "code_information": [{"code": "595602", "type": "CDM"}], "standard_charges": [{"gross_charge": 5277.0, "discounted_cash": 1424.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CASSETTE IRRIGATION HANDPIECE SNGL TPS", "code_information": [{"code": "5100050001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 121.37, "discounted_cash": 32.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CASTING TAPE DELTA-LITE PLUS  3\" X 4YD DARK BLUE 73458-21", "code_information": [{"code": "73458-21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.66, "discounted_cash": 3.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH  IV AUTOGUARD INSYTE 22GX1.00 381423", "code_information": [{"code": "381423", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 8.27, "discounted_cash": 2.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH  IV AUTOGUARD INSYTE 24GX0.75 381412", "code_information": [{"code": "381412", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 16.88, "discounted_cash": 4.56, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH EMBOLECTOMY 2FR 40CM", "code_information": [{"code": "E1601-24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.5, "discounted_cash": 46.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH EMBOLECTOMY 2FR 60CM", "code_information": [{"code": "E1601-26", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.6, "discounted_cash": 63.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH EMBOLECTOMY 3 FR 80CM", "code_information": [{"code": "E1601-38", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.6, "discounted_cash": 63.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH EMBOLECTOMY 3FR 40CM", "code_information": [{"code": "E1601-34", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.8, "discounted_cash": 56.92, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH EMBOLECTOMY 4 FR 80CM", "code_information": [{"code": "E1601-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.6, "discounted_cash": 44.71, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY 12FR 2W 5CC (REPL 0165SI12)", "code_information": [{"code": "175812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.93, "discounted_cash": 5.11, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY COUNCIL RD-LTX 18FR 5ML 0196L18", "code_information": [{"code": "196L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.37, "discounted_cash": 6.04, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH FOLEY SILICONE 14FR 5CC", "code_information": [{"code": "175814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.31, "discounted_cash": 5.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV AUTO INSYTE BC GRN 18GX.1.16 382644", "code_information": [{"code": "382644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.55, "discounted_cash": 2.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV AUTOGUARD INSYTE 18GX1.16 381444", "code_information": [{"code": "381444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.34, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SAFETY 18G X2.5 FEP STRGHT 4252561-02", "code_information": [{"code": "4252561-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.05, "discounted_cash": 2.17, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SAFETY 20G X1.25 FEP STRGHT 4252535-02", "code_information": [{"code": "4252535-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.58, "discounted_cash": 8.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SAFETY 20G X1.75 FEP STRGHT 4252527-02", "code_information": [{"code": "4252527-02", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.6, "discounted_cash": 2.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH IV SFTY INTROCAN 18GA X 1-1/4 TEF", "code_information": [{"code": "4252560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.11, "discounted_cash": 2.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH PLACE CARDIO BRACHYTX", "code_information": [{"code": "92974", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH SUCTION 8FR DELEE TIP STRT", "code_information": [{"code": "DYND41908", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/EMBOL", "code_information": [{"code": "C7515", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIAL CIR W/STENTS", "code_information": [{"code": "C7514", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/ANGIO DIALCIR W/APLASTY", "code_information": [{"code": "C7513", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATH/APLASTY DIAL CIR W/STNT", "code_information": [{"code": "C7530", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CATHETER  IV AUTOGUARD INSYTE 16GX1.77", "code_information": [{"code": "381457", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.55, "discounted_cash": 2.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER 14FR 30MM 90CM 10CM MOO554500", "code_information": [{"code": "MOO554500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2008.5, "discounted_cash": 542.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER AND GLOVE SUCTION KIT", "code_information": [{"code": "140050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 17460.0, "discounted_cash": 4714.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ARROW RADIAL ARTERY 20GA 1-3/4", "code_information": [{"code": "ARA-04020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.01, "discounted_cash": 13.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BILIARY DRAIN SILICON T-TUBE 4 FR SU130-1208", "code_information": [{"code": "SU130-1208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 884.4, "discounted_cash": 238.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER BILIARY DRAIN SILICONE T-TUBE SU130-1228", "code_information": [{"code": "SU130-1228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 884.4, "discounted_cash": 238.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EMBOLECTOMY 40 CM 3FR FOGARTY ARTERIAL", "code_information": [{"code": "120403F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.54, "discounted_cash": 29.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EMBOLECTOMY 40 CM 4FR FOGARTY ARTERIAL", "code_information": [{"code": "120404F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.54, "discounted_cash": 29.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EPI 19GA X 12IN RADIO OPAQUE ROUND DEFLECTIVE ATRAUMATIC TIP BREVI-XL", "code_information": [{"code": "155-2340", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 260.0, "discounted_cash": 70.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EPI 21GA X 12IN RADIO OPAQUE SPRING WOUND STYLETTED W/ STYLET EPI NDL V", "code_information": [{"code": "156-2112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 264.72, "discounted_cash": 71.47, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER EPIDURAL 20G CLOSED END W/CONN WITH STYLET", "code_information": [{"code": "4918-16/17", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.26, "discounted_cash": 20.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 6FR 18MM TO 20MM 180 CM 8 CM PYLORIC FIXED WIRE BLLN DILATOR", "code_information": [{"code": "M00558381", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 592.02, "discounted_cash": 159.85, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 7.5FR 12MM TO 15MM 180 CM 5.5 CM PYLORIC WIRE GUIDED BLLN DI", "code_information": [{"code": "M00558420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 667.92, "discounted_cash": 180.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 7.5FR 15MM TO 18MM 240 CM 5.5 CM PYLORIC COLONIC WIRE GUIDED", "code_information": [{"code": "M00558490", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 667.92, "discounted_cash": 180.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESOPHAGEAL 7.5FR 18MM TO 20MM 240 CM 5.5 CM COLONIC WIRE GUIDED BLLN DI", "code_information": [{"code": "M00558500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 667.92, "discounted_cash": 180.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER ESPH PYL 7.5FR 15-18MM 180CM 5.5CM WG BLNDIL CRE", "code_information": [{"code": "M00558430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 690.69, "discounted_cash": 186.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FEMALE EXTERNAL PUREWICK", "code_information": [{"code": "BRDPWF030H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.08, "discounted_cash": 9.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 100% SILICNE 12FR 5ML 165812", "code_information": [{"code": "165812", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.62, "discounted_cash": 5.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 100% SILICNE 18FR 5ML 165818", "code_information": [{"code": "165818", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.17, "discounted_cash": 4.1, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 14FR 10 ML UNCOATED SILICONE", "code_information": [{"code": "165814", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.1, "discounted_cash": 4.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16 FRENCH 5 ML RED COUNCIL 2 WAY", "code_information": [{"code": "196L16", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.09, "discounted_cash": 14.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 10 ML COUDE STYLE LATEX", "code_information": [{"code": "DYND11216", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.93, "discounted_cash": 4.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 2 LEVEL", "code_information": [{"code": "A899916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.84, "discounted_cash": 14.54, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5 ML URETHRAL TWO WAY SILICONE HYDROGEL LUBRISIL STERILE", "code_information": [{"code": "175816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.31, "discounted_cash": 5.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 16FR 5CC URETHRAL DRAINAGE 100 PCT SILICONE", "code_information": [{"code": "165816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.77, "discounted_cash": 4.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 18FR 5 ML URETHRAL TWO WAY SILICONE 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45.62, "discounted_cash": 12.32, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 5CC 14 FRENCH RED", "code_information": [{"code": "102L14", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.84, "discounted_cash": 12.38, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY 8FR 3CC 2 WAY BLLN SILICONE STRL PEDI DISP", "code_information": [{"code": "165PL08", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.19, "discounted_cash": 8.96, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE 18FR 5CC 2-WAY 0168L18", "code_information": [{"code": "168L18", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.34, "discounted_cash": 11.97, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER FOLEY COUDE LATEX 14FR 10ML DYND11214", "code_information": [{"code": "DYND11214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.94, "discounted_cash": 1.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER HOLDER TUBING FOLEY ADHESIVE 2X3 DYND16700", "code_information": [{"code": "DYND16700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.83, "discounted_cash": 1.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 14GA X 1 3/4IN ORANGE SHIELDED NDL STR NOTCHEDINSYTE AUTOGUARD LF ST", "code_information": [{"code": "381467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.66, "discounted_cash": 2.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA 1 1/8IN VIALON RADIOPAQUE LATEX-FREE", "code_information": [{"code": "381484", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.77, "discounted_cash": 2.37, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA 1.25IN RADPQ SFSHLD", "code_information": [{"code": "425253502A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.57, "discounted_cash": 8.52, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA X 1 1/4IN PROTECTIV PLUS", "code_information": [{"code": "3066", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA X 1 1/4IN PROTECTIV PLUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3066", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV 20GA X 1 1/4ININTRAVENOUS STRAIGHT POLY 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{"description": "CATHETER IV AUTO INSYTE BC PINK 20GX.1 382533", "code_information": [{"code": "382533", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.99, "discounted_cash": 2.43, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV AUTOGUARD INSYTE 24GX0.75 381512", "code_information": [{"code": "381512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.27, "discounted_cash": 2.23, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SAF-T-INTIMA 22GX0.75 383322", "code_information": [{"code": "383322", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.88, "discounted_cash": 4.56, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER IV SAFETY 22G X1 FEP STRGHT 4252519-02", "code_information": [{"code": "4252519-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.88, "discounted_cash": 2.13, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER KIT INTRODUCER SUPRAPUBIC 16 FR ORANGE SF-S16-100", "code_information": [{"code": "SF-S16-100", "type": "CDM"}], "standard_charges": [{"gross_charge": 186.42, "discounted_cash": 50.33, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 2-WAY 16FR 30CC SILICONE DISP", "code_information": [{"code": "176816", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.2, "discounted_cash": 6.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 3-WAY 22FR 30CC SILICONE DISP", "code_information": [{"code": "73022L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.67, "discounted_cash": 14.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER LUBRISIL 3-WAY 24FR 30CC SILICONE DISP", "code_information": [{"code": "73024L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.67, "discounted_cash": 14.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER MULTI LMN 7FR 16CM CDC-42703-XP1A", "code_information": [{"code": "CDC-42703-XP1A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 433.84, "discounted_cash": 117.14, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER MULTI-LUMEN CENTRAL VENOUS CATH KIT", "code_information": [{"code": "ARWAKWAK22703", "type": "CDM"}], "standard_charges": [{"gross_charge": 269.35, "discounted_cash": 72.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PASSER", "code_information": [{"code": "8591-60", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 114.75, "setting": "both", "billing_class": "facility"}]}, {"description": "CATHETER PLUG 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF BLADDER TUBE", "code_information": [{"code": "51710", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE OF URETER TUBE/STENT", "code_information": [{"code": 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE STENT VIA TRANSURETH", "code_information": [{"code": "50385", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANGE URETER STENT PERCUT", "code_information": [{"code": "50382", "type": "CPT"}], 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHANNEL ADAPTER M 8 10CM", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": "2311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4890.0, "discounted_cash": 1320.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CHANNEL BONE NANO FX PLEURISTIKINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "FURS-2001", "type": "CDM"}, {"code": "278", "type": 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"plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMICAL PEEL NONFACIAL", "code_information": [{"code": "15792", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMILUMINESCENT ASSAY", 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO HORMON ANTINEOPL SQ/IM", "code_information": [{"code": "96402", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSE EACH ADDL HR", "code_information": [{"code": "96423", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA INFUSION UP TO 1 HR", "code_information": [{"code": "96422", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IA PUSH TECNIQUE", "code_information": [{"code": "96420", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL OVER 7", "code_information": [{"code": "96406", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO INTRALESIONAL UP TO 7", "code_information": [{"code": "96405", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV INFUS EACH ADDL SEQ", "code_information": [{"code": "96417", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH ADDL DRUG", "code_information": [{"code": "96411", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO IV PUSH SNGL DRUG", "code_information": [{"code": "96409", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMO PROLONG INFUSE W/PUMP", "code_information": [{"code": "96416", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENER MUSCLE LARYNX EMG", "code_information": [{"code": "64617", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV 1 EXTREM 1-4 EA", "code_information": [{"code": "64643", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ADDUCT VOCAL", "code_information": [{"code": "S2341", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV ECCRINE GLANDS", "code_information": [{"code": "64653", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC MIGRAINE", "code_information": [{"code": "64615", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV MUSC NECK DYSTON", "code_information": [{"code": "64616", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV SALIV GLANDS", "code_information": [{"code": "64611", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERV TRUNK MUSC 6/>", "code_information": [{"code": "64647", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ABDUCTOR", "code_information": [{"code": "S2340", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ECCRINE GLANDS;BOTH AXILLAE 64650", "code_information": [{"code": "64650", "type": "CPT"}, {"code": "1480254", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2400.0, "discounted_cash": 648.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 4716.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 2568.55, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF ONE EXTREMITY; 5 OR MORE MUSCLES 64644", "code_information": [{"code": "64644", "type": "CPT"}, {"code": "18370595", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1850.0, "discounted_cash": 499.5, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 1387.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CHEMODENERVATION OF TRUNK MUSCLES; 1-5 MUSCLES 64646", "code_information": [{"code": "64646", "type": "CPT"}, {"code": "18370603", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2400.0, "discounted_cash": 648.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, 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"type": "RC"}], "standard_charges": [{"gross_charge": 34.77, "discounted_cash": 9.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANES SZ 3 72IN SNGL LIMB MSK W/ FILTER AND BAG ULTRAFLEX LF ADLT", "code_information": [{"code": "5753F-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.23, "discounted_cash": 11.67, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA 90IN 3LT EXPANDABLE LF ADLT", "code_information": [{"code": "DYNJAA10160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.54, "discounted_cash": 9.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA 90IN EXPANDABLE LF PEDI", "code_information": [{"code": "DYNJAP9830", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 485.28, "discounted_cash": 131.03, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA ADULT 72IN", "code_information": [{"code": "CHAXX7202B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.48, "discounted_cash": 9.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT ANESTHESIA ADULT LF", "code_information": [{"code": "DYNJAAF6410", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.52, "discounted_cash": 10.94, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 70IN UNIVSL SNGL LIMB ANES W/ FILTER AND 2L BAG MASK AND SAMPL", "code_information": [{"code": "DF475V-6121Z", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.8, "discounted_cash": 9.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT BREATHING 90IN PEDI ANESTHESIA", "code_information": [{"code": "WCPOCGM90A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.23, "discounted_cash": 7.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT GAS SAMPLING LINE 0.05\"  7066", "code_information": [{"code": "7066", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT KIT ANES PEDS EXTENDAFLEX EX-LF DYNJAP7211", "code_information": [{"code": "DYNJAP7211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.83, "discounted_cash": 8.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT PEDI 90IN EXPANDABLE TBG 20 EA/CS", "code_information": [{"code": "WCP43SS90A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.84, "discounted_cash": 6.17, "setting": "both", "billing_class": "facility"}]}, {"description": "CIRCUIT PEDIATRC UNIVERSAL F2 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"standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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[{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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1061.91, "discounted_cash": 286.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP BONE H2 MICRO LENGTHENER PERP CLAMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "4960-3-025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1966.35, "discounted_cash": 530.91, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP CEMNT PATELLA SERIES 1", "code_information": [{"code": "32-348150", "type": "CDM"}], "standard_charges": [{"gross_charge": 681.0, "discounted_cash": 183.87, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP COMBINATION LG FXTNINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "390.005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2298.78, "discounted_cash": 620.67, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP FIXATION HOFFMAN II TITANIUM MULTI PIN 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{"description": "CLAMP GRASPING 10MM X 31CM ENDO BABCOCK 34 X 44MM JAW 360DEG ROTATATION", "code_information": [{"code": "174001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 644.35, "discounted_cash": 173.97, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP HEAD PROVISIONAL MICROPLASTY", "code_information": [{"code": "31-555530", "type": "CDM"}], "standard_charges": [{"gross_charge": 3528.0, "discounted_cash": 952.56, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP LG MULTI PIN 6 HOLE 390.004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "390.004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2535.45, "discounted_cash": 684.57, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAMP NECK ARTERY", "code_information": [{"code": "61703", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, 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{"description": "CLAW TRIAL 100MM SM ARCOS", "code_information": [{"code": "31-302102", "type": "CDM"}], "standard_charges": [{"gross_charge": 3192.0, "discounted_cash": 861.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAW TROCHANTERIC LG CO CR MALLORY HEAD", "code_information": [{"code": "11-105021", "type": "CDM"}], "standard_charges": [{"gross_charge": 1884.0, "discounted_cash": 508.68, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAW TROCHANTERIC LG MODULAR FEMORAL REVISOIN SYS ARCOS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-302101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2787.0, "discounted_cash": 752.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CLAW TROCHANTERIC MED CO CR MALLORY HEAD", "code_information": [{"code": "11-105020", "type": "CDM"}], "standard_charges": [{"gross_charge": 1884.0, "discounted_cash": 508.68, 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{"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 60.21, "discounted_cash": 16.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEANSER WND 20 ML GENERAL PURP POUR BOTTLE FOR USE ON ACUTE NON SURG TRAUMATIC", "code_information": [{"code": "121222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.83, "discounted_cash": 1.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEAR EYELID GLAND W/HEAT", "code_information": [{"code": "207T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEAR GUARD LE ENDOSCOPIC SOFT TISSUE RELEASE SYS CGD 001", "code_information": [{"code": "CGD 001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2853.5, "discounted_cash": 770.45, "setting": "both", "billing_class": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEAR OUTER EAR CANAL", "code_information": [{"code": "69205", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEAR PLASTIC DRAPE 24X32 WITH 5.5 SQUARE FENESTRATION WITH ASHESIVE PAINDRAPE5", "code_information": [{"code": "PAINDRAPE5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.38, "discounted_cash": 4.15, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31720", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee 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HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARANCE OF AIRWAYS", "code_information": [{"code": "31725", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLEARLINK INJECTION SITE LUER ACTIVATED 415122", "code_information": [{"code": "415122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.88, "discounted_cash": 1.86, "setting": "both", "billing_class": "facility"}]}, {"description": "CLEAT MINI VITALLIUM DALL-MILES", "code_information": [{"code": "6704-8-030", "type": "CDM"}], "standard_charges": [{"gross_charge": 758.1, "discounted_cash": 204.69, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINCH ENDOSCOPIC II 5MM 174317", "code_information": [{"code": "174317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 623.47, "discounted_cash": 168.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 150MG/ML IV SOL 2ML", "code_information": [{"code": "MED0611", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.77, "discounted_cash": 2.37, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN 600MG/50ML D5W IV SOL", "code_information": [{"code": "MED0580", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.31, "discounted_cash": 9.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN PHOS 900 MG VIAL 50 ML", "code_information": [{"code": "228546", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 36.13, "discounted_cash": 9.76, "setting": "both", "billing_class": "facility"}]}, {"description": "CLINDAMYCIN/CLEOCIN 2% VAG CREAM 40GM", "code_information": [{"code": "MED0063", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 230.57, "discounted_cash": 62.25, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ANCHOR 235CM ENDO RESOLUTION 360", "code_information": [{"code": "M00521230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 590.7, "discounted_cash": 159.49, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP APPLIER LIGACLIP ENDO ROTATNG S ER420", "code_information": [{"code": "ER420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.03, "discounted_cash": 60.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP BLADE FOR USE W/ CARPAL TUNNEL RELEASE SYS SECURITY DISP", "code_information": [{"code": "200068", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 735.9, "discounted_cash": 198.69, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP BONE 25 X 22MM EASYCLIP OSTEOTOMY FOOT HAND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EZ25-22-22", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5309.1, "discounted_cash": 1433.46, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ENDO LG 10MM PISTOL GRIP APPLIE 176625", "code_information": [{"code": "176625", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 514.69, "discounted_cash": 138.97, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ENDOSCOPIC III 5MM SINGLE USE 176630", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "176630", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1440.07, "discounted_cash": 388.82, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP ESOPHAGEAL DEVICE LOWER QUICKCLIP PRO", "code_information": [{"code": "HX-202LR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 133.11, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP FAN 6IN WHT ON PATIENT HVY DTY RUBBER GRIP METAL AND PLASTIC", "code_information": [{"code": "EPI25971", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 68.63, "discounted_cash": 18.53, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP FIXATION 10MM X 10MM X 10MM EASYCLIP IMPLANT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EZM10-10-10", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2842.2, "discounted_cash": 767.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP FXTN 10MM X 10MM X 10MM EASYCLIP IMP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "EZM10-10-10S", 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235 CM 2.8MM 11MM OPENING APPLIER RESOLUTION RADIOPAQUE", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "M00522610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 493.0, "discounted_cash": 133.11, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP HEMOSTATIC 235 CM HEMOCLIPS RESOLUTION", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "2261", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 441.0, "discounted_cash": 119.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP IRRIGATION 111331", "code_information": [{"code": "111331", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.05, "discounted_cash": 76.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP IRRIGATION CLIP", "code_information": [{"code": "116239", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.05, "discounted_cash": 76.42, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING 5MM ENDO W/ SUPERINTERLOCK ENDO CLIP DISP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "176620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 905.97, "discounted_cash": 244.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING HEMOCLIP PLUS YELLOW SM TI STRL", "code_information": [{"code": "5-33837", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.75, "discounted_cash": 8.3, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING LG ENDOINT HEMOCLIP LF SS STRL DISP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "HUD523470", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 54.78, "discounted_cash": 14.79, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING LG ENDOINT HEMOCLIP LF TI STRL DISP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "523170", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 45.6, "discounted_cash": 12.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING MED BLUE SURG GRADE TANTALUM HEMOCLIP", "code_information": [{"code": "A4649", "type": "HCPCS"}, {"code": "523100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 315.99, "discounted_cash": 85.32, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING MED ENDOINT HEMOCLIP LF SS STRL DISP", "code_information": [{"code": "C1760", "type": "HCPCS"}, {"code": "HUD523600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13.11, "discounted_cash": 3.54, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING MED LG ENDOINT HORIZON LF TI STRL DISP", "code_information": [{"code": "PLW03200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.15, "discounted_cash": 5.44, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING SM PILLING TANTALUM", "code_information": [{"code": "W523100", "type": "CDM"}], "standard_charges": [{"gross_charge": 4.97, "discounted_cash": 1.34, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP LIGATING TITANIUM MEDIUM 002200", "code_information": [{"code": "2200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP MAKO IRRIGATION 6MM EMAX II ANSPACH", "code_information": [{"code": "IRR-CLIP-40", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.75, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP OBTURATOR", "code_information": [{"code": "200069", "type": "CDM"}], "standard_charges": [{"gross_charge": 843.0, "discounted_cash": 227.61, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP RESOLUTION 360 ULTRA M00521400", "code_information": [{"code": "M00521400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 656.7, "discounted_cash": 177.31, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP RESOLUTION BX 20 M00522612", "code_information": [{"code": "M00522612", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 247.35, "discounted_cash": 66.78, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIP SUTURE ENDO ABS 2-0/3-0/4-0 VICRYL XC200", "code_information": [{"code": "XC200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.88, "discounted_cash": 59.37, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPPER BLADE UNI GRAY", "code_information": [{"code": "DYND70880", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.32, "discounted_cash": 3.6, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPPER BLADE UNIVERSAL FLAT SMBLADEUF", "code_information": [{"code": "SMBLADEUF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.49, "discounted_cash": 2.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS ADHESIVE  74017-001", "code_information": [{"code": "74017-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 96.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS ADHESIVE 74007", "code_information": [{"code": "L8679", "type": "HCPCS"}, {"code": "74007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 2.7, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS ADHESIVE 74007-001", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74007-001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS ADHESIVE NALU 74007-002", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74007-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 81.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS ADHESIVE PACK (COMFORT) 74007-003", "code_information": [{"code": "74007-003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 96.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS EXTRA LIGATING TITANUM LIGACLIP MD LT200", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "LT200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6.97, "discounted_cash": 1.88, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS EXTRA LIGATING TITANUM LIGACLIP SM LT100", "code_information": [{"code": "LT100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.38, "discounted_cash": 1.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS LIGATING TITANIUM MED/LARGE 003200", "code_information": [{"code": "3200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.2, "discounted_cash": 5.45, "setting": "both", "billing_class": "facility"}]}, {"description": "CLIPS TD2 ADHESIVE N246150", "code_information": [{"code": "N246150", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 357.0, "discounted_cash": 96.39, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE 100 MCG/ML INTRATHECAL SOL 10 ML", "code_information": [{"code": "MED0687", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 37.47, "discounted_cash": 10.12, "setting": "both", "billing_class": "facility"}]}, {"description": "CLONIDINE/EPI/KETOR/ROPIV 0.04 mg-0.25 mg-15 mg-123 mg/50 mL", "code_information": [{"code": "MED0869", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.35, "setting": "both", "billing_class": "facility"}]}, {"description": "CLORPACTIN WCS-90 TOPICAL POWDER", "code_information": [{"code": "MED0559", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 27.52, "discounted_cash": 7.43, "setting": "both", "billing_class": "facility"}]}, {"description": "CLOSD RDUCTN SPLINT ALVEOLUS", "code_information": [{"code": "D7670", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE BLADDER-UTERUS FISTULA", "code_information": [{"code": "51920", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE BRONCHIAL FISTULA", 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total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE CHEST AFTER DRAINAGE", "code_information": [{"code": "32810", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 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schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE KIDNEY-SKIN FISTULA", "code_information": [{"code": "50520", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MASTOID FISTULA", "code_information": [{"code": "69700", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD", "code_information": [{"code": "33675", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE MULT VSD W/RESECTION", "code_information": [{"code": "33676", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50525", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE NEPHROVISCERAL FISTULA", "code_information": [{"code": "50526", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68760", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSE TEAR DUCT OPENING", "code_information": [{"code": "68761", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE OF WINDPIPE LESION", "code_information": [{"code": "31820", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLOSURE SKIN 1/2IN X 4 1/2IN DYNAMIC DYNACLOSE", "code_information": [{"code": "DWC24", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.2, "discounted_cash": 5.99, "setting": "both", "billing_class": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLSD TX PELVIC RING FX", "code_information": [{"code": "27198", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX CLAVICULAR FX W/MNPJ", "code_information": [{"code": "23505", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX GR HMRL TBRS FX WO MNPJ", "code_information": [{"code": "23620", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"billing_class": "facility"}]}, {"description": "CLTX MEDIAL ANKLE FX", "code_information": [{"code": "27760", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX POST ANKLE FX", "code_information": [{"code": "27767", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX PROX HUMRL FX W/O MNPJ", "code_information": [{"code": "23600", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SCAP FX W/MNPJ +-TRACTJ", "code_information": [{"code": "23575", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SCAPULAR FX W/O MNPJ", "code_information": [{"code": "23570", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX SHO DISLC NECK FX MNPJ", "code_information": [{"code": "23675", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX STRNCLAV DISLC W/O MNPJ", "code_information": [{"code": "23520", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CLTX THIGH FX", "code_information": [{"code": "27267", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CMBN AP COLPRHY W/NTRCL RPR", "code_information": [{"code": "57265", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC AORTA", "code_information": [{"code": "75600", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 384.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTRAST EXAM THORACIC 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"standard_charge_dollar": 785.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL 360 SYSTEM ANATOMIC BIPLANAR FIXATION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "sk12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11400.0, "discounted_cash": 3078.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL AQUEOUS LEVEL 1", "code_information": [{"code": "6F12-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.42, "discounted_cash": 3.08, "setting": "both", "billing_class": "facility"}]}, {"description": "CONTROL I-STAT LVL 1", "code_information": [{"code": "151230", "type": "CDM"}], "standard_charges": [{"gross_charge": 76.18, "discounted_cash": 20.57, "setting": "both", "billing_class": 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3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 4027.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42970", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42971", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL NOSE/THROAT BLEEDING", "code_information": [{"code": "42972", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CONTROL OF NOSEBLEED", "code_information": [{"code": "30901", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee 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"discounted_cash": 939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS CUTTING GD SZ 5", "code_information": [{"code": "402655", "type": "CDM"}], "standard_charges": [{"gross_charge": 3480.0, "discounted_cash": 939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS CUTTING GD SZ 6", "code_information": [{"code": "402656", "type": "CDM"}], "standard_charges": [{"gross_charge": 3480.0, "discounted_cash": 939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS CUTTING GD SZ 7", "code_information": [{"code": "402657", "type": "CDM"}], "standard_charges": [{"gross_charge": 3480.0, "discounted_cash": 939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS CUTTING GD SZ 8", "code_information": [{"code": "402658", "type": "CDM"}], "standard_charges": [{"gross_charge": 3480.0, "discounted_cash": 939.6, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS PROVISIONAL SZ 1", "code_information": [{"code": "402661", "type": "CDM"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS PROVISIONAL SZ 2", "code_information": [{"code": "402662", "type": "CDM"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS PROVISIONAL SZ 3", "code_information": [{"code": "402663", "type": "CDM"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS PROVISIONAL SZ 4", "code_information": [{"code": "402664", "type": "CDM"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS PROVISIONAL SZ 5", "code_information": [{"code": "402665", "type": "CDM"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS PROVISIONAL SZ 6", "code_information": [{"code": "402666", "type": "CDM"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS PROVISIONAL SZ 7", "code_information": [{"code": "402667", "type": "CDM"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND EAS PROVISIONAL SZ 8", "code_information": [{"code": "402668", "type": "CDM"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND GLEN REAMER ADAPTER", "code_information": [{"code": "402648", "type": "CDM"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 97.2, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL DRILL GD SZ 1", "code_information": [{"code": "402600", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL DRILL GD SZ 2", "code_information": [{"code": "402601", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL DRILL GD SZ 3", "code_information": [{"code": "402602", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL DRILL GD SZ 4", "code_information": [{"code": "402604", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL DRILL GD SZ 5", "code_information": [{"code": "402606", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL DRILL GD SZ 6", "code_information": [{"code": "402607", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL DRILL GD SZ 7", "code_information": [{"code": "402609", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL DRILL GD SZ 8", "code_information": [{"code": "402608", "type": "CDM"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL EXTRACTOR FORCEPS", "code_information": [{"code": "402640", "type": "CDM"}], "standard_charges": [{"gross_charge": 4200.0, "discounted_cash": 1134.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL PROVISIONAL SZ 1", "code_information": [{"code": "402630", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL PROVISIONAL SZ 2", "code_information": [{"code": "402631", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL PROVISIONAL SZ 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "402632", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL PROVISIONAL SZ 4", "code_information": [{"code": "402634", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL PROVISIONAL SZ 5", "code_information": [{"code": "402636", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL PROVISIONAL SZ 6", "code_information": [{"code": "402637", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL PROVISIONAL SZ 7", "code_information": [{"code": "402639", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND HMRL PROVISIONAL SZ 8", "code_information": [{"code": "402638", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SPADE CUTTER SZ 1 TO 2", "code_information": [{"code": "402610", "type": "CDM"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 141.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SPADE CUTTER SZ 3 TO 8", "code_information": [{"code": "402612", "type": "CDM"}], "standard_charges": [{"gross_charge": 525.0, "discounted_cash": 141.75, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER GD-SZ 1 TO 2", "code_information": [{"code": "402642", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER GD-SZ 3 TO 8", "code_information": [{"code": "402644", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER SZ 1", "code_information": [{"code": "402620", "type": "CDM"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER SZ 2", "code_information": [{"code": "402621", "type": "CDM"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER SZ 4", "code_information": [{"code": "402624", "type": "CDM"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER SZ 5", "code_information": [{"code": "402626", "type": "CDM"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER SZ 6", "code_information": [{"code": "402627", "type": "CDM"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER SZ 7", "code_information": [{"code": "402629", "type": "CDM"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COPELAND SURFACE CUTTER SZ 8", "code_information": [{"code": "402628", "type": "CDM"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COR ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7516", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 9621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO W/ILIC/FEM ANGIO", "code_information": [{"code": "C7517", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/DRUG ADMIN", "code_information": [{"code": "C7558", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ANGIO/VENT W/FFR", "code_information": [{"code": "C7557", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 9621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR ARTERY DISEASE MRNA", "code_information": [{"code": "81493", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 945.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ FLOW RESRV", "code_information": [{"code": "C7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ IVUS OR OCT", "code_information": [{"code": "C7518", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 9621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COR/GFT ANGIO W/ILIC/FEM ANG", "code_information": [{"code": "C7520", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORAIL AMT COLLAR SIZE 13", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "3L92503", "type": "CDM"}, 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[{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORD ELECTROCAUTERY 12FT FORFT SWITCHING BIPOLAR FORCEP", "code_information": [{"code": "135166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.49, "discounted_cash": 2.83, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD ELECTROSURGICAL 10FT MONOPOLAR FOOTSWITCH STRL PEDI DISP", "code_information": [{"code": "E0503", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 34.3, "discounted_cash": 9.26, "setting": "both", "billing_class": "facility"}]}, {"description": "CORD FORCEPS 12FT BIPOLARFT SWITCHING STRL", "code_information": [{"code": "E0509", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.88, "discounted_cash": 6.72, "setting": "both", "billing_class": "facility"}]}, {"description": "CORDERA STEM COLLARED HIP SIZE 12 127 DEG HBS033C121", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "HBS033C121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3400.0, "discounted_cash": 918.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE KIT 315-0021", "code_information": [{"code": "315-0021", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3071.25, "discounted_cash": 829.24, "setting": "both", "billing_class": "facility"}]}, {"description": "CORE NDL BX LNG/MED PERQ", "code_information": [{"code": "32408", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORIN UNIPOLAR ADAPTOR SLEEVE", "code_information": [{"code": "570-00-001", "type": "CDM"}], "standard_charges": [{"gross_charge": 550.2, "discounted_cash": 148.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CORKSCREW 5.5MM BC FT SUTURETAPE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1927BCT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1065.0, "discounted_cash": 287.55, "setting": "both", "billing_class": "facility"}]}, {"description": "CORKSCREW ANCHOR PEEK KNOTLESS 3.9X11.2 #5 SUTURE AR-1941PSV", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1941PSV", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1300.8, "discounted_cash": 351.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CORKSCREW FMRL HD REMOVER", "code_information": [{"code": "425420", "type": "CDM"}], "standard_charges": [{"gross_charge": 1320.0, "discounted_cash": 356.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEA IMPLANT 4320", "code_information": [{"code": "4320", "type": "CDM"}], "standard_charges": [{"gross_charge": 141.0, "discounted_cash": 38.07, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEA WHOLE PRE-CUT FOR ALK", "code_information": [{"code": "V2785", "type": "HCPCS"}, {"code": "V0003000", "type": "CDM"}, {"code": "810", "type": "RC"}], "standard_charges": [{"gross_charge": 9300.0, "discounted_cash": 2511.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CORNEAL HYSTERESIS DETER", "code_information": [{"code": "92145", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL RELAXING INCISION 65772", "code_information": [{"code": "65772", "type": "CPT"}, {"code": "1480439", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "gross_charge": 4437.0, "discounted_cash": 1197.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL SMEAR", "code_information": [{"code": "65430", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORNEAL TISSUE TRANSPLANT", "code_information": [{"code": "65767", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORONARY ART/GRFT ANGIO S&I", "code_information": [{"code": "93455", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECT RECTAL PROLAPSE", "code_information": [{"code": "45541", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION COCK UP 5TH TOE W/PLASTIC SKIN CLOSURE 28286", "code_information": [{"code": "28286", "type": "CPT"}, {"code": "2034644", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "gross_charge": 5029.0, "discounted_cash": 1357.83, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3771.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION EYELID W/IMPLANT", "code_information": [{"code": "67912", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"maximum": 5454.0, "gross_charge": 7161.0, "discounted_cash": 1933.47, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 5370.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 5370.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF ASTIGMATISM", "code_information": [{"code": "65775", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee 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"fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF BLADDER DEFECT", "code_information": [{"code": "51940", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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"RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "gross_charge": 5558.0, "discounted_cash": 1500.66, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS 44055", "code_information": [{"code": "44055", "type": "CPT"}, {"code": "46173420", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 10286.25, "gross_charge": 13715.0, "discounted_cash": 3703.05, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 10286.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CORTICAL FXATION FXD LOOP 25MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "232014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1392.0, "discounted_cash": 375.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CORTICAL FXATION FXD LOOP 30MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "232016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1392.0, "discounted_cash": 375.84, "setting": "both", "billing_class": "facility"}]}, {"description": "CORTICAL IMPLANT RIGIDLOOP ADJ XL 232449", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "232449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1656.0, "discounted_cash": 447.12, "setting": "both", "billing_class": "facility"}]}, {"description": "CORTICAL PREPARATION TOOL", "code_information": [{"code": "245016", "type": 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"type": "RC"}], "standard_charges": [{"gross_charge": 804.38, "discounted_cash": 217.18, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK BONE 7.0MM MONSTER SCREWS", "code_information": [{"code": "P20-910-7000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 804.38, "discounted_cash": 217.18, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 2.8MM AO COUPLING ASNIS STRL DISP", "code_information": [{"code": "45-20007S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 652.08, "discounted_cash": 176.06, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 3.8MM AO COUPLING ASNIS STRL", "code_information": [{"code": "45-30007", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2184.0, "discounted_cash": 589.68, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED 4.0MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "705363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 651.6, "discounted_cash": 175.93, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED FOR 3 MM CANNULATED SCREW", "code_information": [{"code": "310.804", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1451.51, "discounted_cash": 391.91, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED FOR 3.5 MM AND 4 MM CANNULATED SCREW", "code_information": [{"code": "310.86", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1313.57, "discounted_cash": 354.66, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED FOR 4.5MM CANNULATED SCREWS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310.85", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1239.75, "discounted_cash": 334.73, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED FOR 6.5 MM AND 7.3 MM CANNULATED SCREW", "code_information": [{"code": "310.78", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1664.16, "discounted_cash": 449.32, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CANNULATED MONSTER DISP 4.5MM", "code_information": [{"code": "P20-910-4500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 632.78, "discounted_cash": 170.85, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK CORTEX 6MM", "code_information": [{"code": "702811", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1557.6, "discounted_cash": 420.55, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK MANUAL", "code_information": [{"code": "320-0024", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 578.88, "discounted_cash": 156.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK MONSTER 7.0MM HEADLESS SCREW", "code_information": [{"code": "P20-915-7000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 804.38, "discounted_cash": 217.18, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW 2MM TO 2.4MM MANUAL", "code_information": [{"code": "320-1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 742.5, "discounted_cash": 200.48, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SCREW 4MM CANNULATED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8943-05", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 705.0, "discounted_cash": 190.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK STRYKR END 53MM SCREW 1.7MM", "code_information": [{"code": "60-80117", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 283.39, "discounted_cash": 76.52, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SURG FOR 3.5 MM CORTEX AND 4 MM CANCELLOUS BONE SCREW", "code_information": [{"code": "310.89", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 456.21, "discounted_cash": 123.18, "setting": "both", "billing_class": "facility"}]}, {"description": "COUNTERSINK SURG FOR 4.5 MM SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "310.99", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 771.21, "discounted_cash": 208.23, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLER DIAPHYSEAL 10CM TOTAL FEMORAL ONCOLOGY SALVAGE SYS", "code_information": [{"code": "150462R", "type": "CDM"}], "standard_charges": [{"gross_charge": 16932.5, "discounted_cash": 4571.78, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLER OFFSET 4MM LEGION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71424225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3903.0, "discounted_cash": 1053.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLER OFFSET POSITIVE 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "71424227", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3903.0, "discounted_cash": 1053.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLER PWR REAMER VANGUARD", "code_information": [{"code": "32-488040", "type": "CDM"}], "standard_charges": [{"gross_charge": 3240.0, "discounted_cash": 874.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLER REAMER PATELLA", "code_information": [{"code": "32-347811", "type": "CDM"}], "standard_charges": [{"gross_charge": 2649.0, "discounted_cash": 715.23, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLING PIN TO ROD 3-4/5MM HII COMPACT MRI", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4941-1-020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1044.48, "discounted_cash": 282.01, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLING QUICK LG", "code_information": [{"code": "338.49", "type": "CDM"}], "standard_charges": [{"gross_charge": 3865.55, "discounted_cash": 1043.7, "setting": "both", "billing_class": "facility"}]}, {"description": "COUPLING SURG ROD TO ROD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4922-1-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2058.42, "discounted_cash": 555.77, "setting": "both", "billing_class": "facility"}]}, {"description": "COUTERSINK 2.7/3.5MM", "code_information": [{"code": "45-80040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 324.29, "discounted_cash": 87.56, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER BACK TABLE STERILE-Z XL 88 X 140 5575XL", "code_information": [{"code": "5575XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.5, "discounted_cash": 23.09, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER BACK TABLE TRANSPORT POLY XL RED DISP SINGLE USE", "code_information": [{"code": "5540XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 56.73, "discounted_cash": 15.32, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER EYE W/MEMBRANE", "code_information": [{"code": "65778", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVER HANDLE LIGHT FLEXIBLE GREEN 5128-FG", "code_information": [{"code": "5128-FG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HANDLE LIGHT FLEXIBLE GRN 2EA/ 5160-2FG", "code_information": [{"code": "5160-2FG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HANDLE LIGHT FLEXIBLE SOFT LF STRL", "code_information": [{"code": "DYNJLHS1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER HANDLE LIGHT FLEXIBLE SOFT OPERATING ROOM LF STRL", "code_information": [{"code": "DYNJLHS2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER K-WIRE .0454IN WHT PIN LF STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C-045", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 21.81, "discounted_cash": 5.89, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER K-WIRE .062IN GRN FOR STEINMANN PINN AND KIRSCHNER WIRE LF STRL", "code_information": [{"code": "C-062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.33, "discounted_cash": 1.17, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER LIGHT HANDLE FLEXIBLE GLVLITE LF STRL DISP", "code_information": [{"code": "31140208", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.66, "discounted_cash": 0.99, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER LIGHTHANDLE STERILE BLUE LB53", "code_information": [{"code": "LB53", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.55, "discounted_cash": 1.77, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PIN 0.035IN SZ 0.9 BLUE STEINMANN PIN KIRSCHNER WIRE POST SURG FOR PROTRUD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "C-035", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8.7, "discounted_cash": 2.35, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PIN YELLOW STD SNGL USE NURSING SUPPLY THERMOPLASTIC PROTECT FROM SHARP EN", "code_information": [{"code": "101001PBX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 147.25, "discounted_cash": 39.76, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PLASTIC MAYO STAND 22/CS BXT8339", "code_information": [{"code": "BXT8339", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.01, "discounted_cash": 2.43, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PLATE LONESTAR 10-14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "83-7120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER POST SURG .028IN YELLOW STEINMANN PIN KIRSCHNER WIRE STRL", "code_information": [{"code": "C-028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.84, "discounted_cash": 43.97, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER POST SURG .54IN RED STRAIGHT FOR STEINMANN PINN AND K-WIRE LATEX FREE STER C-054", "code_information": [{"code": "C-054", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.16, "discounted_cash": 2.47, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER PROBE FLEXI-FEEL W/GEL 6\" X 24\" 25-FF624", "code_information": [{"code": "25-FF624", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.15, "discounted_cash": 4.09, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER SHOE SMS DURA-FIT X-LG 4854", "code_information": [{"code": "4854", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND 24IN X 53IN BLUE MAYO LF STRL", "code_information": [{"code": "DYNJP2500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.38, "discounted_cash": 1.18, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND MAYO 23PLACTIC FOB 30 CS", "code_information": [{"code": "8337", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.83, "discounted_cash": 1.3, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER STAND XL 30IN X 57IN MAYO PP LF STRL", "code_information": [{"code": "DYNJP2510", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.49, "discounted_cash": 2.29, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER SURGI-BOOT TRANSDUCER", "code_information": [{"code": "610-797", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.01, "discounted_cash": 23.76, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TABLE 44IN X 90IN SURG REINFORCED LF STRL DISP", "code_information": [{"code": "DYNJP2311", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.38, "discounted_cash": 1.72, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TABLE 77IN X 96IN DRP", "code_information": [{"code": "DYNJP2313", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.47, "discounted_cash": 8.77, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TABLE BACK 44X75 STERILE 8376", "code_information": [{"code": "8376", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.68, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER TRANSDUCER 29-PCS0330LF", "code_information": [{"code": "29-PCS0330LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.47, "discounted_cash": 7.42, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER ULTRASOUND PROBE 2.37 X 9.5 W/STERILE GEL PEC-01NS", "code_information": [{"code": "PEC-01NS", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "COVER ULTRASOUND PROBE TRANSDUCER 3.5IN X 24IN STERILE 610-001", "code_information": [{"code": "610-001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 28.68, "discounted_cash": 7.74, "setting": "both", "billing_class": "facility"}]}, {"description": "COVERSECLIPSE ENDOCAVITY PROBE COVERS 911436 911436", "code_information": [{"code": "911436", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.38, "discounted_cash": 1.45, "setting": "both", "billing_class": "facility"}]}, {"description": "COVID-19 LAB TEST NON-CDC", "code_information": [{"code": "U0002", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.18, "maximum": 46.18, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "COVIDIEN SPACEMAKER PLUS DISSECTOR SYSTEM WITH 5MM CONVERTER 10MM - 12MM", "code_information": [{"code": "SMSBTRND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1582.26, "discounted_cash": 427.21, "setting": "both", "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE 1ST 60 MIN", "code_information": [{"code": "99487", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPLX CHRNC CARE EA ADDL 30", "code_information": [{"code": "99489", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPTR OPHTH DX IMG POST SEGMT", "code_information": [{"code": "92134", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CPTRIZED CORNEAL TOPOGRAPHY", "code_information": [{"code": "92025", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRANIOFACIAL APPROACH SKULL", "code_information": [{"code": "61580", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 8880.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CREATE EARDRUM OPENING", "code_information": [{"code": "69433", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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{"description": "CREATION OF LESION BY STEREOTACTIC METHOD PERCT. 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CROSS-PLATE COMPRESSION T8 LEFT METATARSAL PHALLANGEAL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": 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INSERT 28MM ID", "code_information": [{"code": "2041C-2846", "type": "CDM"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSFIRE SERIES II 10?? INSERT 32MM ID", "code_information": [{"code": "2041C-3250", "type": "CDM"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSFIRE SERIES II INS 0 26M", "code_information": [{"code": "2043C-2642", "type": "CDM"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSFIRE SERIES II INS 10  26", "code_information": [{"code": "2041C-2642", "type": "CDM"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSFIRE SERIES II INS 20  28", "code_information": [{"code": "2042C-2848", "type": "CDM"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSFIRE SERIES II INS 20  32", "code_information": [{"code": "2042C-3256", 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"standard_charges": [{"gross_charge": 3150.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINKED POLYETHYLENE RIGHT 16MM 42-5221-007-16", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5221-007-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3150.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CROSSLINKED POLYTHYLENE 11MM VIVACIT-E HIGHLY 42-5221-008-11", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5221-008-11", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3150.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUCIATE RETAINING FEMORAL TRIATHLON SIZE #7 RIGHT CR", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5517-F-702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5700.0, "discounted_cash": 1539.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH AXILLARY 70-78 650LB HD PUSH BUTTON STEEL", "code_information": [{"code": "CA801TLB", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 111.43, "discounted_cash": 30.09, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH AXILLARY ADULT 62-70 300LB CA901AD", "code_information": [{"code": "CA901AD", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 60.08, "discounted_cash": 16.22, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH AXILLARY TALL 70-78 300LB CA901TL", "code_information": [{"code": "CA901TL", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 65.7, "discounted_cash": 17.74, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH AXILLARY YOUTH SZ 52-62 300LB 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"type": "RC"}], "standard_charges": [{"gross_charge": 60.75, "discounted_cash": 16.4, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH WALKING CHILD SZ PEDI", "code_information": [{"code": "MDS803372", "type": "CDM"}], "standard_charges": [{"gross_charge": 39.9, "discounted_cash": 10.77, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCH WALKING MED PUSH BTN 300 POUND ECONOMY ALUMINUM SAFE-GARD ADLT", "code_information": [{"code": "MDSV80535", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 14.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CRUTCHES ADULT 61-69IN BARIATRIC 650LB PUSH BUTTON ADJUSTABLE", "code_information": [{"code": "IPR-AXI-0022", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 109.57, "discounted_cash": 29.58, "setting": "both", "billing_class": "facility"}]}, {"description": "CRYOABLATE 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 12311.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 13479.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOABLATE RENAL MASS OPEN", "code_information": [{"code": "50250", "type": "CPT"}], "standard_charges": [{"minimum": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVATION SPERM", "code_information": [{"code": "89259", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 134.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE STEM CELLS", "code_information": [{"code": "38207", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOPRESERVE TESTICULAR TISS", "code_information": [{"code": "89335", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURG ABLATE FA EACH", "code_information": [{"code": "19105", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY ANAL LESION(S)", "code_information": [{"code": "46916", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOSURGERY PENIS LESION(S)", "code_information": [{"code": "54056", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYOTHERAPY OF SKIN", "code_information": [{"code": "17340", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOCOCCUS ANTIBODY", "code_information": [{"code": "86641", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 12.44, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CRYPTOSPORIDIUM AG IF", "code_information": [{"code": "87272", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CS ALL-POLYETHYLENE TIBIA COMP 5534-A-511", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5534-A-511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 1782.0, "setting": "both", "billing_class": "facility"}]}, {"description": "CSF LEAKAGE IMAGING", "code_information": [{"code": "78650", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 413.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed 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payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF SHUNT REPROGRAM", "code_information": [{"code": "62252", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSF VENTRICULOGRAPHY", "code_information": [{"code": "78635", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 394.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE DETC ABNOR ALLELE", "code_information": [{"code": "81188", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE FULL GENE SEQUENCE", "code_information": [{"code": "81189", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CSTB GENE KNOWN FAMIL VRNT", "code_information": [{"code": "81190", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT 3D Reconstruction 76376", "code_information": [{"code": "76376", "type": "CPT"}, {"code": "615588", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1103.0, "discounted_cash": 297.81, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 94.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 613.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT 3D Rend w/ Interp & Rpt w/ Spvs 76377", "code_information": [{"code": "76377", "type": "CPT"}, {"code": "4424436", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1103.0, "discounted_cash": 297.81, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 85.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 613.26, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abd and Pelvis w/ + w/o Con 74178", "code_information": [{"code": "74178", "type": "CPT"}, {"code": "1171864", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1794.0, "discounted_cash": 484.38, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 997.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abd and Pelvis w/o Contrast  74176", "code_information": [{"code": "74176", "type": "CPT"}, {"code": "1171868", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abdomen and Pelvis w/ Contrast  74177", "code_information": [{"code": "74177", "type": "CPT"}, {"code": "1171869", "type": "CDM"}, {"code": "352", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1794.0, "discounted_cash": 484.38, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 997.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abdomen w/ + w/o Contrast 74170", "code_information": [{"code": "74170", "type": "CPT"}, {"code": "615590", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 502.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 325.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abdomen w/ Contrast 74160", "code_information": [{"code": "74160", "type": "CPT"}, {"code": "625598", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1300.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 398.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 722.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 264.47, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Abdomen w/o Contrast 74150", "code_information": [{"code": "74150", "type": "CPT"}, {"code": "625600", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1078.0, "discounted_cash": 291.06, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 279.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 599.36, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 183.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Ankle w/ + w/o Contrast Bl 73702", "code_information": [{"code": "73702", "type": "CPT"}, {"code": "625680", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3053.0, "discounted_cash": 824.31, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 475.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1697.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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475.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 316.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Ankle w/ + w/o Contrast Right  73702", "code_information": [{"code": "73702", "type": "CPT"}, {"code": "625684", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 475.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"description": "CT Bone Mineral Density Study 77078", "code_information": [{"code": "77078", "type": "CPT"}, {"code": "1171876", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 403.0, "discounted_cash": 108.81, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 109.34, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 224.06, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 238.69, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Femur w/ Contrast Right 73701", "code_information": [{"code": "73701", "type": "CPT"}, {"code": "629848", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 188.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Femur w/o Contrast Right 73700", "code_information": [{"code": "73700", "type": "CPT"}, {"code": "629854", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1078.0, "discounted_cash": 291.06, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 287.25, "methodology": "fee 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"gross_charge": 1078.0, "discounted_cash": 291.06, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 286.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 599.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 188.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Guidance Tissue Ablation 77013", "code_information": [{"code": "77013", "type": "CPT"}, {"code": "629916", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1667.0, "discounted_cash": 450.09, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 331.15, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 926.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Guidance for Injection 77012", "code_information": [{"code": "77012", "type": "CPT"}, {"code": "629910", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1667.0, "discounted_cash": 450.09, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 172.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 926.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Guidance for needle placement 77012", "code_information": [{"code": "77012", "type": "CPT"}, {"code": "1171883", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1667.0, "discounted_cash": 450.09, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 172.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 926.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Guide for Stereotactic Loc 77011", "code_information": [{"code": "77011", "type": "CPT"}, {"code": "629920", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1667.0, "discounted_cash": 450.09, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 955.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 926.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HRT C+ STRUX CGEN HRT DS", "code_information": [{"code": "75573", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 405.66, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HRT W/3D IMAGE", "code_information": [{"code": "75572", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 337.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HRT W/O DYE W/CA TEST", "code_information": [{"code": "75571", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 68.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Hand w/ + w/o Cont Bilateral  73202", "code_information": [{"code": "73202", "type": "CPT"}, {"code": "629926", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3053.0, "discounted_cash": 824.31, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 474.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1697.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 315.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 315.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Hand w/ + w/o Contrast Right", "code_information": [{"code": "73202", "type": "CPT"}, {"code": "629938", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 474.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 315.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Hand w/ Contrast Bilateral 73201", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "629934", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2602.0, "discounted_cash": 702.54, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 354.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1446.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 236.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Hand w/ Contrast Left 73201", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "629940", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1300.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 354.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 722.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 236.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Hand w/ Contrast Right 73201", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "629944", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1300.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 354.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 722.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 236.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Hand w/o Contrast Bilateral 73200", "code_information": [{"code": "73200", "type": "CPT"}, {"code": "629948", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2155.0, "discounted_cash": 581.85, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 286.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", 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"additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 316.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Knee w/ Contrast Bilateral 73701", "code_information": [{"code": "73701", "type": "CPT"}, {"code": "630036", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2602.0, "discounted_cash": 702.54, "setting": "both", 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{"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1300.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 429.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 722.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 289.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Orbit Sella Ear w/+ w/o Cont Rt 70482", "code_information": [{"code": "70482", "type": "CPT"}, {"code": "1171865", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 499.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 325.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Orbit Sella Ear w/+w/o Cont Bl 70482", "code_information": [{"code": "70482", "type": "CPT"}, {"code": "1668327", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3053.0, "discounted_cash": 824.31, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 499.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1697.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 325.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Orbit Sella Ear w/+w/o Cont Lt 70482", "code_information": [{"code": "70482", "type": "CPT"}, {"code": "1171866", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 499.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 325.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Orbit Sella Ear w/o Contrast 70480", "code_information": [{"code": "70480", "type": "CPT"}, {"code": "1171871", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1078.0, "discounted_cash": 291.06, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 293.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 599.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 188.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT OrbitSella Ear w/ Cont Right 70481", "code_information": [{"code": "70481", "type": "CPT"}, {"code": "1171872", "type": "CDM"}, {"code": "350", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1300.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 429.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 722.8, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 289.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PERFUSION W/CONTRAST CBF", "code_information": [{"code": "42T", "type": "CPT"}], "standard_charges": [{"minimum": 1.06, "maximum": 575.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 575.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Pelvis w/ + w/o Contrast 72194", "code_information": [{"code": "72194", "type": "CPT"}, {"code": "630108", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 467.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 309.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Pelvis w/ Contrast 72193", "code_information": [{"code": "72193", "type": "CPT"}, {"code": "630112", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1300.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 350.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 722.8, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 231.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Pelvis w/o Contrast 72192", "code_information": [{"code": "72192", "type": "CPT"}, {"code": "630114", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1078.0, "discounted_cash": 291.06, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 282.25, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 599.36, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 184.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SCAN F/BIOMCHN CT ALYS", "code_information": [{"code": "558T", "type": "CPT"}], "standard_charges": [{"minimum": 212.65, "maximum": 1384.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 575.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 212.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT SCAN FOR THERAPY GUIDE", "code_information": [{"code": "77014", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 213.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Shoulder w/ + w/o Contrast Bl  73202", "code_information": [{"code": "73202", "type": "CPT"}, {"code": "630128", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3053.0, "discounted_cash": 824.31, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 474.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1697.46, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 315.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Shoulder w/ + w/o Contrast Left 73202", "code_information": [{"code": "73202", "type": "CPT"}, {"code": "630132", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 474.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 315.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Shoulder w/ + w/o Contrast Rt  73202", "code_information": [{"code": "73202", "type": "CPT"}, {"code": "630134", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 474.05, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 849.56, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 315.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Shoulder w/ Contrast Bilateral  73201", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "630136", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2602.0, "discounted_cash": 702.54, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 354.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1446.71, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 236.04, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Shoulder w/ Contrast Left 73201", "code_information": [{"code": "73201", "type": "CPT"}, {"code": "630138", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1300.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 354.53, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, 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"additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1384.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Spine Cervical w/o Contrast 72125", "code_information": [{"code": "72125", "type": "CPT"}, {"code": "629610", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 293.92, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 305.81, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Spine Lumbar w/ Contrast 72132", "code_information": [{"code": "72132", "type": "CPT"}, {"code": "630052", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1300.0, "discounted_cash": 351.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 368.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 316.73, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 191.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT Tibia/Fibula w/ + w/o Cont Lt  73702", "code_information": [{"code": "73702", "type": "CPT"}, {"code": "630184", "type": "CDM"}, {"code": "359", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1528.0, "discounted_cash": 412.56, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 475.16, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": 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"UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGE OR EXCISION OF BONE CYST TIBIA OR FIBULA 27635", "code_information": [{"code": "27635", "type": "CPT"}, {"code": "1480519", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6752.25, "gross_charge": 9003.0, "discounted_cash": 2430.81, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6752.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CURETTAGEOR EXCISION BONE CYST WITH AUTOGRAFT TIBIA OR FIBULA 27637", 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 10505.25, "methodology": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO LASER TX URETERAL CALC", "code_information": [{"code": "S2070", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/ BX(S) W/ BLUE LIGHT", "code_information": [{"code": "C7550", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/PRST8 COMMISSUROTOMY", "code_information": [{"code": "619T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO W/UP STRICTURE TX", "code_information": [{"code": "52342", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO, LITHO, VACUUM KIDNEY", "code_information": [{"code": "C9761", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTO/URETERO STRICTURE TX", "code_information": [{"code": "52344", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND RADIOTRACER", "code_information": [{"code": "52250", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52224", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52285", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52301", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52305", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY AND TREATMENT", "code_information": [{"code": "52315", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY PROSTATIC IMP 1-3", "code_information": [{"code": "C9739", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY REMOVAL OF CLOTS", "code_information": [{"code": "52001", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CYSTOSCOPY STONE REMOVAL", "code_information": [{"code": "52325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 10367.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DECOMPRESS SPINAL CORD THRC", "code_information": [{"code": "63055", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DENGUE VACC QUAD 2 DOSE SUBQ", "code_information": [{"code": "90584", "type": "CPT"}], 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"maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 26.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DEOXYRIBONUCLEASE ANTIBODY", "code_information": [{"code": "86215", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 11.93, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3690.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DERMABRASION OTHER THAN FACE", "code_information": [{"code": "15782", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"standard_charges": [{"gross_charge": 381.72, "discounted_cash": 103.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUT 15CM 14G TROC SITE FACIA", "code_information": [{"code": "PC-120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.25, "discounted_cash": 20.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURE STITCH ENDOSCOPIC 10MM 173016", "code_information": [{"code": "173016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 689.7, "discounted_cash": 186.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 10MM REPROCESS ENDO STITCH DISP", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "173016R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.48, "discounted_cash": 19.57, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE SUTURING 5MM W/ STPCCK VALVE FOR USE W/ VERSAPORT RT REUSABLE CANNULA AND", "code_information": [{"code": "175770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 94.19, "discounted_cash": 25.43, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TARGETING RECAP PIN", "code_information": [{"code": "31-501000", "type": "CDM"}], "standard_charges": [{"gross_charge": 3978.0, "discounted_cash": 1074.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TENSION 20MM W/GA SPAN ARTICULATED", "code_information": [{"code": "321.12", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2604.9, "discounted_cash": 703.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVICE TISSUE CTRL 1 36X36 1/2 CIR TPR SXPD2B405", "code_information": [{"code": "SXPD2B405", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.04, 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"billing_class": "facility"}]}, {"description": "DEVICES IMPLANTABLE VOLAR DISTAL RAD PLT TI NARROW LT 7H AR-8916VNL-07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8916VNL-07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DEVISE BOWEL POUCH", "code_information": [{"code": "44316", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DIAGNOSTIC LARYNGOSCOPY", "code_information": [{"code": "31505", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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"UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF ESOPHAGUS WITH BALLOON 30MM OR LARGER FOR  ACHALASIA 43458", "code_information": [{"code": "11267686", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 4156.0, "discounted_cash": 1122.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DILATION OF SALIVARY DUCT", "code_information": [{"code": "42650", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, 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1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF URETHRA", "code_information": [{"code": "53660", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DILATION OF VAGINA", "code_information": [{"code": "57400", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"DOME IMPACTOR 76MM SHELL REGENEREX", "code_information": [{"code": "31-177776", "type": "CDM"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME MEDIAL ATTUNE PAT 32MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "151820032", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME MEDIAL ATTUNE PAT 38MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "151820038", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 38MM MODULAR ACTBLR", "code_information": [{"code": "29-476038", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, 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{"description": "DOME REAMER 48MM MODULAR ACTBLR", "code_information": [{"code": "29-476048", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 50MM MODULAR ACTBLR", "code_information": [{"code": "29-476050", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 53MM MODULAR ACTBLR", "code_information": [{"code": "29-476053", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 54MM MODULAR ACTBLR", "code_information": [{"code": "29-476054", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 56MM MODULAR ACTBLR", "code_information": [{"code": "29-476056", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 57MM MODULAR ACTBLR", "code_information": [{"code": "29-476057", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 58MM MODULAR ACTBLR", "code_information": [{"code": "29-476058", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 59MM MODULAR ACTBLR", "code_information": [{"code": "29-476059", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 60MM MODULAR ACTBLR", "code_information": [{"code": "29-476060", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 61MM MODULAR ACTBLR", "code_information": [{"code": "29-476061", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 62MM MODULAR ACTBLR", "code_information": [{"code": "29-476062", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 63MM MODULAR ACTBLR", "code_information": [{"code": "29-476063", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DOME REAMER 64MM MODULAR ACTBLR", "code_information": [{"code": "29-476064", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, 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"billing_class": "facility"}]}, {"description": "DOME REAMER 75MM MODULAR ACTBLR", "code_information": [{"code": "29-476075", "type": "CDM"}], "standard_charges": [{"gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DON HYSTERECTOMY LAPS LIV", "code_information": [{"code": "666T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, 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"DONOR PNEUMONECTOMY", "code_information": [{"code": "32850", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPAMINE 1.6MG/ML-D5W INTRAVENOUS SOLUTION 250 ML", "code_information": [{"code": "2B0842", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 29.92, "discounted_cash": 8.08, "setting": "both", "billing_class": "facility"}]}, {"description": "DOPPLER COLOR FLOW ADD-ON", "code_information": [{"code": "93325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DOPPLER ECHO EXAM HEART", "code_information": [{"code": "93320", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DPYD GENE COMMON VARIANTS", "code_information": [{"code": "81232", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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"plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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FLUTED ROUND W/ TROCAR", "code_information": [{"code": "72225", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.58, "discounted_cash": 17.44, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHEST 1 PATIENT TUBE DRY SUCTION OASIS", "code_information": [{"code": "3600-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 97.43, "discounted_cash": 26.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN CHEST LESION", "code_information": [{"code": "21502", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN CHEST PLEUREVAC ADULT-PED DRY A-6000-08LF", "code_information": [{"code": "A-6000-08LF", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 661.16, "discounted_cash": 178.51, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN EXTERNAL EAR LESION", "code_information": [{"code": "69005", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN FLUTE WITH TROCAR FULL ROUND 15FR", "code_information": [{"code": "B072189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.05, "discounted_cash": 20.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN OPEN ABDOM ABSCESS", "code_information": [{"code": "49040", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OPEN RETROPERI ABSCESS", "code_information": [{"code": "49060", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OUTER EAR CANAL LESION", "code_information": [{"code": "69020", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS OPEN", "code_information": [{"code": "58820", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN OVARY ABSCESS PERCUT", "code_information": [{"code": "58822", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN PENIS LESION", "code_information": [{"code": "54015", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN PENROSE .25IN STERILE 30416-025", "code_information": [{"code": "30416-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.72, "discounted_cash": 1.27, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE .5IN X 12IN OPEN WOUND CARE DRAINAGE LATEX STRL", "code_information": [{"code": "912030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE .5IN X 12IN OPEN WOUND CARE DRAINAGE LATEX STRL", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "912030", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 669.39, "discounted_cash": 180.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 0.25IN X 18IN CLOSED WOUND DRAIN WOUND CARE LATEX STRL", "code_information": [{"code": "DYND50420", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.32, "discounted_cash": 1.17, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 1/2 X 18IN PIN", "code_information": [{"code": "20416-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.96, "discounted_cash": 1.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 12 X 1 2 30414-050", "code_information": [{"code": "30414-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.48, "discounted_cash": 1.48, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 12X1 4 1 EACH", "code_information": [{"code": "30414-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.94, "discounted_cash": 1.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE 18IN LATEX FREE DYND50427", "code_information": [{"code": "DYND50427", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.82, "discounted_cash": 2.65, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE DRAIN 18X1 2 067 STAND 30416-050", "code_information": [{"code": "30416-050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.94, "discounted_cash": 1.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE SILICONE  STERILE 18 X 1 DYND50429", "code_information": [{"code": "DYND50429", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.15, "discounted_cash": 5.17, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN PENROSE TMC 18 INCH L X 1 INCH", "code_information": [{"code": "20416-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.27, "discounted_cash": 1.96, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN RESERVOIR 100CC CLR EVACUATOR BULB JACKSON-PRATT SILICONE 70740 (USE 0070740 PART NUMBER)", "code_information": [{"code": "70740 (USE 0070740 PART NUMBER)", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.37, "discounted_cash": 5.77, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND 3/32IN END PERFORATED SILICONE", "code_information": [{"code": "70200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.76, "discounted_cash": 6.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN ROUND CHANNEL TROCAR 15FR 072189", "code_information": [{"code": "72189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 64.76, "discounted_cash": 17.49, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BONE LESION", "code_information": [{"code": "23035", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN SHOULDER BURSA", "code_information": [{"code": "23031", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN SILCN BLAKE 10FR ROUND 1 8 TRC LF 2227", "code_information": [{"code": "2227", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 201.92, "discounted_cash": 54.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SILICON 19FR ROUND CHANNEL", "code_information": [{"code": "72192", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.32, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SILICONE PENROSE PREMIUM STERILE 12 X 0.25 DYND50301", "code_information": [{"code": "DYND50301", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.98, "discounted_cash": 5.12, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SILICONE ROUND 1 8 END PERF 0070310", "code_information": [{"code": "70310", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.63, "discounted_cash": 10.43, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN SPINAL CORD CYST", "code_information": [{"code": "62268", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN SWANSON 7MMX25CM", "code_information": [{"code": "2450-0000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.75, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN THYROID/TONGUE CYST", "code_information": [{"code": "60000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN TO PERITONEAL CAVITY", "code_information": [{"code": "49062", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAIN WND 7FR 3/32IN X 50IN RND END PERFORATION SI WITHOUT TROCAR JACKSON PRATT", "code_information": [{"code": "SU130-1320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.3, "discounted_cash": 8.99, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND 1/4IN 19FR ROUND PERFORATED W/ TROCAR", "code_information": [{"code": "70330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.35, "discounted_cash": 10.62, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND 1/4IN HEMOVAC", "code_information": [{"code": "8412", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.36, "discounted_cash": 20.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND 10MM 3/16IN SILICONE FLAT FULL FLUTED ETHICON BLAKE STRL", "code_information": [{"code": "2215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 247.85, "discounted_cash": 66.92, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND 10MM SILICONE FLAT FULL FLUTED ETHICON BLAKE STRL", "code_information": [{"code": "2214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 216.49, "discounted_cash": 58.45, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND 15FR FULL ROUND FLUTE W/ TROCAR", "code_information": [{"code": "duplicateB072189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.05, "discounted_cash": 20.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND PENROSE SAFTEY PIN 12 X 1/4", "code_information": [{"code": "zz30414-025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.58, "discounted_cash": 0.97, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND 10FR SILICONE HUBLESS ETHICON BLAKE STRL", "code_information": [{"code": "2226", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.59, "discounted_cash": 46.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND 19FR SILICONE HUBLESS BLAKE", "code_information": [{"code": "2230", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.2, "discounted_cash": 33.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAIN WOUND ROUND SILICONE 10FR 1 8 SU130 1321", "code_information": [{"code": "SU130-1321", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.79, "discounted_cash": 12.36, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAINAGE ABDOM ABSCESS OPEN", "code_information": [{"code": "49020", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38300", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE LYMPH NODE LESION", "code_information": [{"code": "38305", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE MOUTH ROOF LESION", "code_information": [{"code": "42000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF ABDOMEN", "code_information": [{"code": "48000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BLADDER ABSCESS", "code_information": [{"code": "51080", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF BONE LESION", "code_information": [{"code": "21510", "type": "CPT"}], "standard_charges": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF FOREARM BURSA", "code_information": [{"code": "25031", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF GUM LESION", "code_information": [{"code": "41800", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF HYDROCELE", "code_information": [{"code": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41009", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41015", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF MOUTH LESION", "code_information": [{"code": "41016", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF NOSE LESION", "code_information": [{"code": "30020", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF RECTAL ABSCESS", "code_information": [{"code": "45020", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY CYST", "code_information": [{"code": "42409", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42300", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF SALIVARY GLAND", "code_information": [{"code": "42320", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF THROAT ABSCESS", 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DRAINAGE OF URETHRA ABSCESS", "code_information": [{"code": "53060", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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ISOLATIONINCISEFILM 1014", "code_information": [{"code": "1014", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.78, "discounted_cash": 12.36, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE STERILE UTILITY SURGICAL  WITH TAPE XL 20\" X 30\" DYNJP2408", "code_information": [{"code": "DYNJP2408", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.33, "discounted_cash": 1.98, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 112IN X 137IN X 89IN HIP ABSORB REINFORCED FENESTRATED W/ POUCH STOP", "code_information": [{"code": "DYNJP8201", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.37, "discounted_cash": 14.41, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 13IN X 13ININCISE ANTIMICROBIAL W/ ADHSV LOBAN LF STRL", "code_information": [{"code": "6648EZ", "type": "CDM"}, {"code": "272", 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[{"gross_charge": 31.36, "discounted_cash": 8.47, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 53IN X 77IN THREE QUARTER PP LF STRL DISP", "code_information": [{"code": "DYNJP2414", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 1.89, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 53IN X 77IN THREE QUARTER REINFORCED GENERAL PURP PROXIMA ECLIPSE LF", "code_information": [{"code": "DYNJP2416", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.49, "discounted_cash": 2.83, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 54IN X 72IN IMPERVIOUS U DRP PROXIMA LF", "code_information": [{"code": "DYNJP2499", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.57, "discounted_cash": 2.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 6IN X 6IN CHEST BREAST PROXIMA FENESTRATED SMS LF STRL DISP", "code_information": [{"code": "DYNJP2492", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.14, "discounted_cash": 6.79, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 70IN X 100IN FULL SMS FABRIC PLYPRPLN LF STRL DISP", "code_information": [{"code": "DYNJP2419", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.66, "discounted_cash": 2.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 74IN X 121IN BILATERAL LIMB PROXIMA LF STRL DISP", "code_information": [{"code": "DYNJP8004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.92, "discounted_cash": 9.16, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 76IN X 120IN BILATERAL LIMB REINFORCED CIRCULAR FENESTRATION TUBE HOL", "code_information": [{"code": "89291", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.51, "discounted_cash": 13.1, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 77IN X 108IN BLUE ADHSV SPLIT CORD AND TUBE HOLDER HOOK AND LOOP PROX", "code_information": [{"code": "DYNJP2498", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.98, "discounted_cash": 6.2, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 78IN X 102IN X 121IN LAPAROTOMY SHT 5 STRONG FIBER LAYER PLYPRPLN DRP", "code_information": [{"code": "DYNJP3003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG 99IN X 110IN LAPARASCOPIC VAGINAL HYSTERECTOMY PP STRL", "code_information": [{"code": "DYNJP9103", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.94, "discounted_cash": 12.67, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG BILATERAL LIMB CUSTOM", "code_information": [{"code": "DYNJCD0056A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.59, "discounted_cash": 14.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG LAPAROTOMY 100IN X 72IN X 124IN", "code_information": [{"code": "89228", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 40.37, "discounted_cash": 10.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG SHLDR BEACH CHAIR PEAR SHAPE FENESTRATION VELCRO CORD HOLDING TABS FL", "code_information": [{"code": "29369", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.7, "discounted_cash": 23.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE SURG XL SHEET FAN FOLDED", 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"both", "billing_class": "facility"}]}, {"description": "DRAPE T 89IN X 122IN X 135IN BLUE EXTREMITY ABSORB TRI LAMINATE STRL DISP", "code_information": [{"code": "DYNJP8003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.52, "discounted_cash": 9.59, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE T 90IN X 122IN X 114IN SURG ARTHRO FENESTRATED ABSORB REINFORCEMENT SMS W/", "code_information": [{"code": "DYNJP8102", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.0, "discounted_cash": 18.9, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TABLE 45IN X 84IN NS", "code_information": [{"code": "174", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.44, "discounted_cash": 1.74, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TABLE IMP PAIN W FACE HOLE 80 CS", "code_information": [{"code": "175-PAIN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.82, "discounted_cash": 4.27, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TIBURON BILATERAL EXTRIMITY", "code_information": [{"code": "29417", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.23, "discounted_cash": 11.94, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TIBURON EXTREMITY W ARMBOARD CO", "code_information": [{"code": "29435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.63, "discounted_cash": 12.32, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TOWEL LARGE INVISISHIELD", "code_information": [{"code": "DYNJSD1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.27, "discounted_cash": 1.15, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TOWEL STERILE LARGE 18 X 24 D1010", "code_information": [{"code": "D1010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.77, "discounted_cash": 1.83, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE TOWEL W/ADHESIVE STRIP 19\" X 30\" 7554", "code_information": [{"code": "7554", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.88, "discounted_cash": 2.13, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE U 60IN X 84IN IMPERVIOUS STRL", "code_information": [{"code": "DYNJP2430", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.37, "discounted_cash": 3.61, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE U PLASTIC 60X84 W ADHESIVE STRIP 8475", "code_information": [{"code": "8475", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 16.73, "discounted_cash": 4.52, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE U W POUCH D1067", "code_information": [{"code": "D1067", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 48.94, "discounted_cash": 13.21, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE UNDER BUTTOCK FLUID COLL POUCH II 8482", "code_information": [{"code": "8482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.87, "discounted_cash": 5.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE UROLOGICAL POLY 47 X 52", "code_information": [{"code": "D1015", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.42, "discounted_cash": 6.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE X-RAY CASSETTE COVER W/ADHESIVE STRIP 24\"X 35\" 30-0101", "code_information": [{"code": "30-0101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 18.65, "discounted_cash": 5.04, "setting": "both", "billing_class": "facility"}]}, {"description": "DRAPE-STERI LARGE IOBAN 2 ISOLATION  6619", "code_information": [{"code": "6619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.72, "discounted_cash": 23.41, "setting": "both", "billing_class": "facility"}]}, {"description": "DRESS/DEBRID P-THICK BURN L", "code_information": [{"code": "16030", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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[{"gross_charge": 2871.0, "discounted_cash": 775.17, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3.5X124MM PROX HMRL RASP", "code_information": [{"code": "414815", "type": "CDM"}], "standard_charges": [{"gross_charge": 6150.0, "discounted_cash": 1660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3.5X124MM RT HMRL TRIAL", "code_information": [{"code": "414845", "type": "CDM"}], "standard_charges": [{"gross_charge": 2871.0, "discounted_cash": 775.17, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3.5X84MM LT HMRL TRL", "code_information": [{"code": "414830", "type": "CDM"}], "standard_charges": [{"gross_charge": 1626.0, "discounted_cash": 439.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3.5X84MM RT HMRL TRL", "code_information": [{"code": "414835", "type": "CDM"}], "standard_charges": [{"gross_charge": 1626.0, "discounted_cash": 439.02, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3MM LT ULNA RASP", "code_information": [{"code": "414861", "type": "CDM"}], "standard_charges": [{"gross_charge": 7365.0, "discounted_cash": 1988.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3MM ULNA FLEX REAMER", "code_information": [{"code": "414851", "type": "CDM"}], "standard_charges": [{"gross_charge": 4185.0, "discounted_cash": 1129.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3X100MM PROX HMRL RASP", "code_information": [{"code": "414810", "type": "CDM"}], "standard_charges": [{"gross_charge": 6150.0, "discounted_cash": 1660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3X115MM LT ULNA TRIAL", "code_information": [{"code": "414881", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3X115MM RT ULNA TRIAL", "code_information": [{"code": "414886", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 3X75MM LT ULNA TRIAL", "code_information": [{"code": "414871", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 4MM DISTAL HMRL RASP", "code_information": [{"code": "414821", "type": "CDM"}], "standard_charges": [{"gross_charge": 6159.0, "discounted_cash": 1662.93, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 4MM LT ULNA RASP", "code_information": [{"code": "414863", "type": "CDM"}], "standard_charges": [{"gross_charge": 7365.0, "discounted_cash": 1988.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 4X100MM LT HMRL TRL", "code_information": [{"code": "414831", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 4X100MM PROX HMRL RASP", "code_information": [{"code": "414811", "type": "CDM"}], "standard_charges": [{"gross_charge": 6150.0, "discounted_cash": 1660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 4X115MM LT ULNA TRIAL", "code_information": [{"code": "414882", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 4X115MM RT ULNA TRIAL", "code_information": [{"code": "414887", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 4X150MM LT HMRL TRL", "code_information": [{"code": "414841", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 4X75MM RT ULNA TRIAL", "code_information": [{"code": "414877", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5 STEP FOSSA REAMER", "code_information": [{"code": "414912", "type": "CDM"}], "standard_charges": [{"gross_charge": 2610.0, "discounted_cash": 704.7, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5MM LT ULNA RASP", "code_information": [{"code": "414865", "type": "CDM"}], "standard_charges": [{"gross_charge": 7365.0, "discounted_cash": 1988.55, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5MM ULNA FLEX REAMER", "code_information": [{"code": "414853", "type": "CDM"}], "standard_charges": [{"gross_charge": 4185.0, "discounted_cash": 1129.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5X100MM PROX HMRL RASP", "code_information": [{"code": "414812", "type": "CDM"}], "standard_charges": [{"gross_charge": 6150.0, "discounted_cash": 1660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5X100MM RT HMRL TRL", "code_information": [{"code": "414837", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5X115MM LT ULNA TRIAL", "code_information": [{"code": "414883", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5X115MM RT ULNA TRIAL", "code_information": [{"code": "414888", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5X150MM PROX HMRL RASP", "code_information": [{"code": "414817", "type": "CDM"}], "standard_charges": [{"gross_charge": 6150.0, "discounted_cash": 1660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5X150MM RT HMRL TRL", "code_information": [{"code": "414847", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5X75MM LT ULNA TRIAL", "code_information": [{"code": "414873", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 5X75MM RT ULNA TRIAL", "code_information": [{"code": "414878", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 6MM DISTAL HMRL RASP", "code_information": [{"code": "414823", "type": "CDM"}], "standard_charges": [{"gross_charge": 6159.0, "discounted_cash": 1662.93, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 6X100MM LT HMRL TRL", "code_information": [{"code": "414833", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 6X100MM PROX HMRL RASP", "code_information": [{"code": "414813", "type": "CDM"}], "standard_charges": [{"gross_charge": 6150.0, "discounted_cash": 1660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 6X150MM LT HMRL TRL", "code_information": [{"code": "414843", "type": "CDM"}], "standard_charges": [{"gross_charge": 2481.0, "discounted_cash": 669.87, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW 7MM ULNA FLEX REAMER", "code_information": [{"code": "414855", "type": "CDM"}], "standard_charges": [{"gross_charge": 4185.0, "discounted_cash": 1129.95, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW AWL RASP", "code_information": [{"code": "414801", "type": "CDM"}], "standard_charges": [{"gross_charge": 1839.0, "discounted_cash": 496.53, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW CONDYLE BROACH", "code_information": [{"code": "414931", "type": "CDM"}], "standard_charges": [{"gross_charge": 3384.0, "discounted_cash": 913.68, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW CONDYLE MANIPULATOR", "code_information": [{"code": "414930", "type": "CDM"}], "standard_charges": [{"gross_charge": 4149.0, "discounted_cash": 1120.23, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW HMRL INSERTER/EXTRACTOR", "code_information": [{"code": "414921", "type": "CDM"}], "standard_charges": [{"gross_charge": 3144.0, "discounted_cash": 848.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW IM AXIS RODS", "code_information": [{"code": "414937", "type": "CDM"}], "standard_charges": [{"gross_charge": 444.0, "discounted_cash": 119.88, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW IM RESECTION GUIDE", "code_information": [{"code": "414936", "type": "CDM"}], "standard_charges": [{"gross_charge": 7836.0, "discounted_cash": 2115.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW PROV LOCK SCREW", "code_information": [{"code": "414806", "type": "CDM"}], "standard_charges": [{"gross_charge": 294.0, "discounted_cash": 79.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW RASP HANDLE", "code_information": [{"code": "414800", "type": "CDM"}], "standard_charges": [{"gross_charge": 3792.0, "discounted_cash": 1023.84, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW SCREW DRIVER HANDLE", "code_information": [{"code": "414922", "type": "CDM"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW T-HANDLE", "code_information": [{"code": "414892", "type": "CDM"}], "standard_charges": [{"gross_charge": 1086.0, "discounted_cash": 293.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW TROUGH RMR", "code_information": [{"code": "414890", "type": "CDM"}], "standard_charges": [{"gross_charge": 3615.0, "discounted_cash": 976.05, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW ULNA BASE REAMER", "code_information": [{"code": "414891", "type": "CDM"}], "standard_charges": [{"gross_charge": 3486.0, "discounted_cash": 941.22, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ELBOW ULNA IMPACTOR", "code_information": [{"code": "414894", "type": "CDM"}], "standard_charges": [{"gross_charge": 1236.0, "discounted_cash": 333.72, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY HMRL IMPACTOR", "code_information": [{"code": "414924", "type": "CDM"}], "standard_charges": [{"gross_charge": 1527.0, "discounted_cash": 412.29, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY ULNA PIN INSERTER", "code_information": [{"code": "414951", "type": "CDM"}], "standard_charges": [{"gross_charge": 3132.0, "discounted_cash": 845.64, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY XS 2PC MALE/FEMAL CONDYLE PROV", "code_information": [{"code": "414897", "type": "CDM"}], "standard_charges": [{"gross_charge": 855.0, "discounted_cash": 230.85, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY XS CONDYLE MANIPULATOR", "code_information": [{"code": "414929", "type": "CDM"}], "standard_charges": [{"gross_charge": 1164.0, "discounted_cash": 314.28, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY XS FOSSA REAMER", "code_information": [{"code": "414913", "type": "CDM"}], "standard_charges": [{"gross_charge": 1203.0, "discounted_cash": 324.81, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY XS HMRL IMPACTOR", "code_information": [{"code": "414927", "type": "CDM"}], "standard_charges": [{"gross_charge": 1041.0, "discounted_cash": 281.07, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY XS HMRL INSERTER/EXTRACTER", "code_information": [{"code": "414920", "type": "CDM"}], "standard_charges": [{"gross_charge": 519.0, "discounted_cash": 140.13, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY XS HMRL RES TEMPLATE", "code_information": [{"code": "414916", "type": "CDM"}], "standard_charges": [{"gross_charge": 846.0, "discounted_cash": 228.42, "setting": "both", "billing_class": "facility"}]}, {"description": "DSCVRY XS IM RESECT GUIDE", "code_information": [{"code": "414938", "type": "CDM"}], "standard_charges": [{"gross_charge": 1653.0, "discounted_cash": 446.31, "setting": "both", "billing_class": "facility"}]}, {"description": "DSPNG PIN MULTI ACCESS MINISPIKE MM412012", "code_information": [{"code": "MM412012", "type": "CDM"}], "standard_charges": [{"gross_charge": 185.5, "discounted_cash": 50.09, "setting": "both", "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G .5 /<", "code_information": [{"code": "17270", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 0.6-1", "code_information": [{"code": "17271", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 1.1-2", "code_information": [{"code": "17272", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 2.1-3", "code_information": [{"code": "17273", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G 3.1-4", "code_information": [{"code": "17274", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LES S/N/H/F/G >4.0", "code_information": [{"code": "17276", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .5/<", "code_information": [{"code": "17280", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M .6-1", "code_information": [{"code": "17281", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M1.1-2", "code_information": [{"code": "17282", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M3.1-4", "code_information": [{"code": "17284", "type": "CPT"}], 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTR MAL LS F/E/E/N/L/M>4.0", "code_information": [{"code": "17286", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L .6-1.0CM", "code_information": [{"code": "17261", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 1.1-2.0", "code_information": [{"code": "17262", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ MAL LES T/A/L 2.1-3.0", "code_information": [{"code": "17263", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DSTRJ NEUROFIBROMA XTNSV", "code_information": [{"code": "419T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DUAL TIP MARKER WITH LABELS 070", "code_information": [{"code": "SPP99DT2AA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.11, "discounted_cash": 1.38, "setting": "both", "billing_class": "facility"}]}, {"description": "DUMBBELL REMOVAL BIPOLAR LINER", "code_information": [{"code": "31-165341", "type": "CDM"}], "standard_charges": [{"gross_charge": 1203.0, "discounted_cash": 324.81, "setting": "both", "billing_class": "facility"}]}, {"description": "DUODENAL EXCLUSION", "code_information": [{"code": "48547", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY EXCL NB", "code_information": [{"code": "31525", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DX LARYNGOSCOPY NEWBORN", "code_information": [{"code": "31520", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY STUDY", "code_information": [{"code": "77085", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXA BONE DENSITY/PERIPHERAL", "code_information": [{"code": "77081", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 26.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "DXTEND GLENOSPHERE ECC D42MM", "code_information": [{"code": "130760042", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6018.75, "discounted_cash": 1625.06, "setting": "both", "billing_class": "facility"}]}, {"description": "DXTEND GLENOSPHERE STD D38MM", 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"setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM LAT NC 16X160", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192116", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM LAT NC 18X170", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192118", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM LAT NC 19X175", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM LAT NC 20X180", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM LAT NC 7X115", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192107", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM LAT NC 8X120", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 10X130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 11X135", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 12X140", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 13X145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 14X150", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 15X155", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192515", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 16X160", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 17X165", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192517", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 18X170", "code_information": [{"code": "192518", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 20X180", "code_information": [{"code": "192520", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 21X185", "code_information": [{"code": "192521", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 8X120", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192508", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED LAT NC 9X125", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192509", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED NC 15X155", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192415", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED NC 18X170", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192418", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED NC 19X175", "code_information": [{"code": "192419", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED NC 20X180", "code_information": [{"code": "192420", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED NC 21X185", "code_information": [{"code": "192421", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FEM RED NC 7X115", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192407", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 10X130", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 11X135", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 13X145", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 17X165", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 18X170", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 19X175", "code_information": [{"code": "192019", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 20X180", "code_information": [{"code": "192020", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 21X185", "code_information": [{"code": "192021", "type": "CDM"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 7X115", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 8X120", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO BIMETRIC POR FMRL NC 9X125", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "192009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 22635.0, "discounted_cash": 6111.45, "setting": "both", "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76516", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 58.75, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76519", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 65.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76529", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 57.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE THICKNESS", "code_information": [{"code": "76514", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 26.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76825", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 188.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 533.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76826", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 114.9, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76827", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 57.64, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76828", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 32.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF HEAD", "code_information": [{"code": "76506", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 94.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM UTERUS", "code_information": [{"code": "76831", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 125.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR AMNIOCENTESIS", "code_information": [{"code": "76946", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 31.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR ARTERY REPAIR", "code_information": [{"code": "76936", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 163.28, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 296.86, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR HEART BIOPSY", "code_information": [{"code": "76932", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 58.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE OVA ASPIRATION", "code_information": [{"code": "76948", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 32.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE VILLUS SAMPLING", "code_information": [{"code": "76945", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 54.18, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93312", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93313", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93314", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93315", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93316", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93317", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL (TEE)", "code_information": [{"code": "93355", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL INTRAOP", "code_information": [{"code": "93318", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93303", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93304", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHOSCLEROTHERAPY", "code_information": [{"code": "S2202", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS DAILY MGMT ARTERY", "code_information": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INITIATION ARTERY", 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{"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33955", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS INSJ CTR CANNULA", "code_information": [{"code": "33956", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33959", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECMO/ECLS REPOS PERPH CNULA", "code_information": [{"code": "33962", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRANSNASAL BX 1/MLT", "code_information": [{"code": "653T", "type": "CPT"}], 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL DPLMNT BALO", "code_information": [{"code": "43290", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD FLX TRNSORL RMVL BALO", "code_information": [{"code": "43291", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD OPTICAL ENDOMICROSCOPY", "code_information": [{"code": "43252", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD TUBE/CATH INSERTION", "code_information": [{"code": "43241", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD US FINE NEEDLE BX/ASPIR", "code_information": [{"code": "43242", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EGD VOL ADJMT BARIATRIC BALO", "code_information": [{"code": "813T", "type": "CPT"}], 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], 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"type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 611.38, "discounted_cash": 165.07, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDO SLEEVE GASTRO W/TUBE", "code_information": [{"code": "C9784", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDO US-GUIDE HEP PORTO GRAD", "code_information": [{"code": "C9768", "type": "HCPCS"}], "standard_charges": [{"minimum": 2444.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOBLADE GASTROC RECESSION SYS", "code_information": [{"code": "AR-8855-DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2908.75, "discounted_cash": 785.36, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOBUTTON 10MM CL ULTRA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72203331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 930.0, "discounted_cash": 251.1, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOCERV CURETTAGE W/SCOPE", "code_information": [{"code": "57456", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOCERVICAL CURETTAGE 57505", "code_information": [{"code": "57505", "type": "CPT"}, {"code": "1480685", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 4437.0, "discounted_cash": 1197.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOGLIDE LUBRICATING GEL", "code_information": [{"code": "SLT-395-50", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "discounted_cash": 2.55, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOKIT COMPLIANCE - CLENAING SPONGE + PURA ENZYMATIC SIK-242", "code_information": [{"code": "SIK-242", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.21, "discounted_cash": 3.57, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOKNOT 0 VICRYL COATED 42 JK10G", "code_information": [{"code": "JK10G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.37, "discounted_cash": 23.59, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLOOP 0 PDSII LIGATURE 18 EZ10G", "code_information": [{"code": "EZ10G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 92.08, "discounted_cash": 24.86, "setting": "both", "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX BILIARY TREE", "code_information": [{"code": "47543", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee 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HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINAL BX URTR RNL PLVS", "code_information": [{"code": "50606", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOLUMINL IVUS OCT C 1ST", "code_information": [{"code": "92978", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVASC VISC AORTA 4 GRAFT", "code_information": [{"code": "34844", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES 1ST", "code_information": [{"code": "36482", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVEN THER CHEM ADHES SBSQ", "code_information": [{"code": "36483", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER 1ST VEIN", "code_information": [{"code": "36478", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"billing_class": "facility"}]}, {"description": "ENDOVENOUS LASER VEIN ADDON", "code_information": [{"code": "36479", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP EA DUCT/AMPULLA DILATE", "code_information": [{"code": "43277", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP REMOVE FORGN BODY DUCT", "code_information": [{"code": "43275", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP RMV CALC PANCREATOSCOPY", "code_information": [{"code": "C7544", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ERCP STENT EXCHANGE W/DILATE", "code_information": [{"code": "43276", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPH SCOPE W/SUBMUCOUS INJ", "code_information": [{"code": "43201", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MOTILITY STUDY", "code_information": [{"code": "78258", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 269.83, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGEAL MUCOSAL INTEGRITY TESTING; ELECTRICAL IMPEDANCE TRANSORAL C9777", "code_information": [{"code": "C9777", "type": "HCPCS"}, {"code": "46463125", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "gross_charge": 7610.0, "discounted_cash": 2054.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID BALLOON", "code_information": [{"code": "43195", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID OR FLEX DIAG W/ OR W/O BRUSH/WASH 43200", "code_information": [{"code": "43200", "type": "CPT"}, {"code": "1601525", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 4156.0, "discounted_cash": 1122.12, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3117.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCOPY RIGID TRNSO", "code_information": [{"code": "43180", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO BIOPSY", "code_information": [{"code": "43193", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESOPHAGOSCP RIG TRNSO REM FB", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62192", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62200", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62220", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ESTABLISH BRAIN CAVITY SHUNT", "code_information": [{"code": "62223", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EVASC RPR A-BIILIAC RPT", "code_information": [{"code": "34706", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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OF NEUROMA HAND OR FOOT EA. ADD. 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESS SKIN FAT PAD", "code_information": [{"code": "15838", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN HIP", "code_information": [{"code": "15834", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE EXCESSIVE SKIN LEG", "code_information": [{"code": "15833", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE INTRSPINL LESION THRC", "code_information": [{"code": "63266", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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"maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PAROTID GLAND/LESION", "code_information": [{"code": "42425", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE PHARYNX LESION", "code_information": [{"code": "42808", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISE SACRAL SPINE TUMOR", "code_information": [{"code": "49215", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION BENIGN LESION 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"standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6013.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION GRAFT ABDOMEN", "code_information": [{"code": "35907", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, 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"standard_charge_dollar": 3772.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF CHALAZION;SINGLE 67800", "code_information": [{"code": "67800", "type": "CPT"}, {"code": "1480827", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2969.0, "discounted_cash": 801.63, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 8157.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF LESION CONJUNCTIVA;OVER 1 CM 68110", "code_information": [{"code": "68110", "type": "CPT"}, {"code": "1480838", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 4906.0, "discounted_cash": 1324.62, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3711.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF SKIN/TISSUE HIDRADENITIS SIMPLE 11462", "code_information": [{"code": "11462", "type": "CPT"}, {"code": "1480864", "type": "CDM"}, {"code": 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43610", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF STOMACH LESION", "code_information": [{"code": "43611", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE FOLD", "code_information": [{"code": "41115", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41110", "type": "CPT"}], 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF TONGUE LESION", "code_information": [{"code": "41113", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXCISION OF VAGINAL SEPTUM 57130", 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[{"code": "418024", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 14X22MM TRIAL HEAD", "code_information": [{"code": "418033", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 14X24MM TRIAL HEAD", "code_information": [{"code": "418043", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 16X18MM TRIAL HEAD", "code_information": [{"code": "418015", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 16X22MM TRIAL HEAD", "code_information": [{"code": "418034", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 16X24MM TRIAL HEAD", "code_information": [{"code": "418044", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 18X18MM TRIAL HEAD", "code_information": [{"code": "418016", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 18X20MM TRIAL HEAD", "code_information": [{"code": "418026", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 18X22MM TRIAL HEAD", "code_information": [{"code": "418035", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 18X24MM TRIAL HEAD", "code_information": [{"code": "418045", "type": "CDM"}], "standard_charges": [{"gross_charge": 552.0, "discounted_cash": 149.04, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 5X22MM RASP", "code_information": [{"code": "418070", "type": "CDM"}], "standard_charges": [{"gross_charge": 4776.0, "discounted_cash": 1289.52, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 5X22MM TRIAL STEM", "code_information": [{"code": "418060", "type": "CDM"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 152.28, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 6X24MM RASP", "code_information": [{"code": "418071", "type": "CDM"}], "standard_charges": [{"gross_charge": 4776.0, "discounted_cash": 1289.52, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 6X24MM TRIAL STEM", "code_information": [{"code": "418061", "type": "CDM"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 152.28, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 7X26MM RASP", "code_information": [{"code": "418072", "type": "CDM"}], "standard_charges": [{"gross_charge": 4776.0, "discounted_cash": 1289.52, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 7X26MM TRIAL STEM", "code_information": [{"code": "418062", "type": "CDM"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 152.28, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 8X28MM RASP", "code_information": [{"code": "418073", "type": "CDM"}], "standard_charges": [{"gross_charge": 4776.0, "discounted_cash": 1289.52, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 8X28MM TRIAL STEM", "code_information": [{"code": "418063", "type": "CDM"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 152.28, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 9X30MM RASP", "code_information": [{"code": "418074", "type": "CDM"}], "standard_charges": [{"gross_charge": 4776.0, "discounted_cash": 1289.52, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR 9X30MM TRIAL STEM", "code_information": [{"code": "418064", "type": "CDM"}], "standard_charges": [{"gross_charge": 564.0, "discounted_cash": 152.28, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR HEAD INSERTER/EXTRACTOR", "code_information": [{"code": "418082", "type": "CDM"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR OFFSET HANDLE", "code_information": [{"code": "418078", "type": "CDM"}], "standard_charges": [{"gross_charge": 3576.0, "discounted_cash": 965.52, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR RAD HEAD SYS-INST CS", "code_information": [{"code": "593650", "type": "CDM"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLOR STEM INSERTER/EXTRACTOR", "code_information": [{"code": "418092", "type": "CDM"}], "standard_charges": [{"gross_charge": 2568.0, "discounted_cash": 693.36, "setting": "both", "billing_class": "facility"}]}, {"description": "EXPLORATION ABDOMINAL WALL 49000", "code_information": [{"code": "49000", "type": "CPT"}, {"code": "1480916", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 8338.5, "gross_charge": 11118.0, "discounted_cash": 3001.86, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee 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"setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION BEHIND UPPER JAW", "code_information": [{"code": "31040", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54550", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION FOR TESTIS", "code_information": [{"code": "54560", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": 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1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "32100", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 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"standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF CHEST", "code_information": [{"code": "39010", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATION OF KIDNEY", "code_information": [{"code": "50010", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": 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1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORATORY SHOULDER SURGERY", "code_information": 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ABDOMINAL VESSELS", "code_information": [{"code": "35840", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60540", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ADRENAL GLAND", "code_information": [{"code": "60545", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST FREE ADHESIONS", "code_information": [{"code": "32124", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE CHEST VESSELS", "code_information": [{"code": "35820", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE DEEP NODE(S) NECK", "code_information": [{"code": "38542", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE EPIDIDYMIS", "code_information": [{"code": "54865", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE LIMB VESSELS", "code_information": [{"code": "35860", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE ORBIT/REMOVE LESION", "code_information": [{"code": "61333", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE PARATHYROID GLANDS", "code_information": [{"code": "60505", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE SINUS REMOVE POLYPS", "code_information": [{"code": "31032", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/DRAIN EYE SOCKET", "code_information": [{"code": "67405", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXPLORE/REPAIR CHEST", "code_information": [{"code": "32110", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"description": "EXPLORE/TREAT EYE SOCKET", "code_information": [{"code": "67413", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE HYSTERECTOMY", "code_information": [{"code": "58285", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 3100.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE MASTOID SURGERY", "code_information": [{"code": "69511", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE PROSTATE SURGERY", "code_information": [{"code": "55865", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"description": "EXTENSIVE REMOVAL OF LIVER", "code_information": [{"code": "47122", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE STERNUM SURGERY", "code_information": [{"code": "21630", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42842", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42844", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE SURGERY OF THROAT", "code_information": [{"code": "42845", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE TESTIS SURGERY", "code_information": [{"code": "54535", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "EXTENSIVE VULVA SURGERY", "code_information": [{"code": "56630", "type": "CPT"}], "standard_charges": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FETAL SURG CONG CYST MALF", "code_information": [{"code": "S2402", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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{"description": "FIBERSTITCH IMPLANT REVERSE CURVE AR-4570R", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4570R", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1609.74, "discounted_cash": 434.63, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERSTITCH MESH ANCHOR 1.5 CURVED AR-4580", "code_information": [{"code": "C1781", "type": "HCPCS"}, {"code": "AR-4580", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1788.15, "discounted_cash": 482.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAG TIGHTROPE IMPLANT II ABS AR-1588TNT2", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "AR-1588TNT2", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1316.25, "discounted_cash": 355.39, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK 1.8MM PERC INSERT KIT FOR  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877.31, "discounted_cash": 236.87, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK DISPOSABLES STRAIGHT KIT", "code_information": [{"code": "AR-3638DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 626.01, "discounted_cash": 169.02, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK DOUBLE LOADED KNOTLESS KNEE AR-3740SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3740SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1706.25, "discounted_cash": 460.69, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK KL RC WH/BLK &TT & (BLU) #2 MTS AR-3653SP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-3653SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1723.56, "discounted_cash": 465.36, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAK RC DISPOSABLE KIT", "code_information": [{"code": "AR-3650DS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 697.55, "discounted_cash": 188.34, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAPE 17IN WITH NDL", "code_information": [{"code": "AR-7237-17LN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 697.55, "discounted_cash": 188.34, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBERTAPE CERCLAGE W/O NEEDLE   AR-7268", "code_information": [{"code": "AR-7268", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1673.43, "discounted_cash": 451.83, "setting": "both", "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADATION PRODUCTS", "code_information": [{"code": "85362", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 6.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FIBRIN DEGRADATION QUANT", "code_information": [{"code": "85379", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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"standard_charges": [{"gross_charge": 340.0, "discounted_cash": 91.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUID PRESSURE MUSCLE", "code_information": [{"code": "20950", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUO BILE DUCT IMAGING W/ICG", "code_information": [{"code": "C9776", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.06, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOCINONIDE 0.05%/15GM CREAM LIDEX", "code_information": [{"code": "MED0081", "type": "CDM"}, {"code": "250", "type": 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"standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENCE LYMPH MAP W/ICG", "code_information": [{"code": "C9756", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT ANTIBODY SCREEN", "code_information": [{"code": "86255", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORESCENT ANTIBODY TITER", "code_information": [{"code": "86256", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO EXAM OF G/COLON TUBE", "code_information": [{"code": "49465", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUORO POLARIZE FETAL LUNG", "code_information": [{"code": "83663", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUOROMETHOLONE 0.1% OPHTH 5ML DROPS", "code_information": [{"code": "MED0084", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 244.63, "discounted_cash": 66.05, "setting": "both", "billing_class": "facility"}]}, {"description": "FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP; SPINE INJ. 77003", "code_information": [{"code": "77003", "type": "CPT"}, {"code": "10481801", "type": "CDM"}, {"code": "329", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1667.0, "discounted_cash": 450.09, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 44.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 926.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FLUTES 2MM X 8MM LONG TM12008", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TM12008", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 879.0, "discounted_cash": 237.33, "setting": "both", "billing_class": "facility"}]}, {"description": "FMR1 GEN ALY DETC ABNL ALLEL", "code_information": [{"code": "81243", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 51.34, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMR1 GEN ALYS CHARAC ALLELES", "code_information": [{"code": "81244", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 40.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRI BRAIN BY PHYS/PSYCH", "code_information": [{"code": "70555", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 211.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FMRL RESEC INSTR CASE", "code_information": [{"code": "592204", "type": "CDM"}], "standard_charges": [{"gross_charge": 7878.0, "discounted_cash": 2127.06, "setting": "both", "billing_class": "facility"}]}, {"description": "FNA BX W/CT GDN 1ST LES", "code_information": [{"code": "10009", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FNA BX W/MR GDN 1ST LES", "code_information": [{"code": "10011", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOAM PRE-TREATMENT BLU62 GALLON 3000-007-000", "code_information": [{"code": "3000-007-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 91.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FOAM STABILITY FETAL LUNG", "code_information": [{"code": "83662", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 17.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLOW-UP ANGIOGRAPHY", "code_information": [{"code": "75898", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 139.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FOLLOWER PHILLIPS TIP 12FR 14.5IN", "code_information": [{"code": "346112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.16, "discounted_cash": 23.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLLOWER PHILLIPS TIP 14FR 14.5IN", "code_information": [{"code": "346114", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.18, "discounted_cash": 23.81, "setting": "both", "billing_class": "facility"}]}, {"description": "FOLLOWER PHILLIPS TIP 18FR 14.5IN", "code_information": [{"code": "346118", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.18, "discounted_cash": 23.81, "setting": "both", "billing_class": "facility"}]}, {"description": "FOOTWEAR PT CIA LF TERRY SAFETY DBL TREAD GREEN 2XL", "code_information": [{"code": "68125-GRN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.55, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP DISP BIOPSY JUMBO ALLGATOR 3.0MM", "code_information": [{"code": "NBF13-011302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.58, "discounted_cash": 15.01, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP HEMO HALSTED-MOSQUITO CVD 5 MDS1222112F", "code_information": [{"code": "MDS1222112F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP HEMOCRILE CVD 5.5 MDS1225114F", "code_information": [{"code": "MDS1225114F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP RADIAL JAW 4 28MM LARGE BIOPSY", "code_information": [{"code": "M00513330", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.13, "discounted_cash": 13.54, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEP TISSUE ADSON 1X24.75 MDS1018012F", "code_information": [{"code": "MDS1018012F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 15.76, "discounted_cash": 4.26, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ATRAUMATIC ANASTOCLIP VCS 18CM X 1.1MM MED", "code_information": [{"code": "4001-06", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1696.2, "discounted_cash": 457.97, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 2.2MM RADIAL JAW 3", "code_information": [{"code": "1550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.5, "discounted_cash": 20.66, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 2.4MM X 240MM POLYPECTOMY RADIAL JAW 4 HOTINSTR", "code_information": [{"code": "M00515033", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.0, "discounted_cash": 14.58, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 2.8MM X 240 CM ENDO LG CAPACITY W/ NDL RADIAL JAW 4 STRLINSTR", "code_information": [{"code": "M00513331", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.13, "discounted_cash": 13.54, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY 2.8MM X 240 CM ENDO LG CAPACITY W/ NDL RADIAL JAW 4 STRLINSTR DIS", "code_information": [{"code": "M00513332", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.06, "discounted_cash": 12.71, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIOPSY RADIAL JAW W/ NDL 4", "code_information": [{"code": "M00513372", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 65.39, "discounted_cash": 17.66, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIP 33CM 5MM PACKSS CRD GRSP STRL DISP", "code_information": [{"code": "920005PACKS", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPLR 1MM 4.75IN ADSON STRAIGHT SMOOTH TIPINSULATED W/ OLSEN STANDARD TW", "code_information": [{"code": "20-1082KI", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 142.0, "discounted_cash": 38.34, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPLR 4.75IN 1MM TIP STRAIGHT SMOOTH ADSON TWIN PIN CONNECTOR DISP", "code_information": [{"code": "20-1082I", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.45, "discounted_cash": 37.11, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 4.5IN MICRO TIP JEWELERS CAUTERY DR BAKER", "code_information": [{"code": "20-1060K1", "type": "CDM"}], "standard_charges": [{"gross_charge": 119.51, "discounted_cash": 32.27, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR 5MM 33 CM", "code_information": [{"code": "3005-020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1638.0, "discounted_cash": 442.26, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR JEWELERS TYPEINSTR", "code_information": [{"code": "20-106K1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 119.51, "discounted_cash": 32.27, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BIPOLAR MACRO ENDOPATH EBF01", "code_information": [{"code": "EBF01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.99, "discounted_cash": 47.25, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BONE 18MM SERRATED JAW SLF CENTERING SPEED LOCK", "code_information": [{"code": "398.82", "type": "CDM"}], "standard_charges": [{"gross_charge": 3417.86, "discounted_cash": 922.82, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BONE 23MM SERRATED JAW SLF CENTERING SPEED LOCK", "code_information": [{"code": "398.83", "type": "CDM"}], "standard_charges": [{"gross_charge": 3627.81, "discounted_cash": 979.51, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BONE SZ 1 240MM SLF CENTERING SM SERRATED JAW 14 MM SPEED LOCK", "code_information": [{"code": "398.81", "type": "CDM"}], "standard_charges": [{"gross_charge": 3084.41, "discounted_cash": 832.79, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS BX SPK ALGTR JW 1 DRV WRE HNG LNKG 230CM JMB DISP (Single Pack Number is BF41080)", "code_information": [{"code": "BF40181", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 54.68, "discounted_cash": 14.76, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS COMPRESSION", "code_information": [{"code": "3.211.400", "type": "CDM"}], "standard_charges": [{"gross_charge": 3859.38, "discounted_cash": 1042.03, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CUTTING 33 CM X 10MM SERRATED JAWS W/ CORD FOR USE W/ PK G400 GENERATOR", "code_information": [{"code": "921020PK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1709.5, "discounted_cash": 461.57, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS CUTTING 33 CM X 5MM SERRATED JAWS W/ CORD FOR USE W/ PK G400 GENERATOR O", "code_information": [{"code": "920005PK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 986.7, "discounted_cash": 266.41, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS DISSECTING 5MM 33CM GYRUS LYONS", "code_information": [{"code": "942005PK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 818.54, "discounted_cash": 221.01, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS ELECTROSURGICAL BAYONET PENCIL METRIX STRLINSTR REUSE", "code_information": [{"code": "9569575", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 416.5, "discounted_cash": 112.46, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS EXTRACTION LG FOR SCREW", "code_information": [{"code": "3.900.013", "type": "CDM"}], "standard_charges": [{"gross_charge": 1827.8, "discounted_cash": 493.51, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS EXTRACTION SM FOR SCREW", "code_information": [{"code": "3.900.011", "type": "CDM"}], "standard_charges": [{"gross_charge": 1545.56, "discounted_cash": 417.3, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GI DISP CVD", "code_information": [{"code": "915000PK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1029.6, "discounted_cash": 277.99, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS GRASPER 2.3MM X 240 CM 4 PRONG", "code_information": [{"code": "60616", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.56, "discounted_cash": 56.85, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HOLDING 135MM FOR SM PLATE", "code_information": [{"code": "398.99", "type": "CDM"}], "standard_charges": [{"gross_charge": 1131.74, "discounted_cash": 305.57, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HOLDING 135MM W/ FOOT", "code_information": [{"code": "399", "type": "CDM"}], "standard_charges": [{"gross_charge": 1078.44, "discounted_cash": 291.18, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HOLDING BONE SOFT RATCHET FOR PLATE", "code_information": [{"code": "399.091", "type": "CDM"}], "standard_charges": [{"gross_charge": 2321.8, "discounted_cash": 626.89, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HOLDING FOR CERCLAGE EYES AND POSITIONING PIN", "code_information": [{"code": "391.885", "type": "CDM"}], "standard_charges": [{"gross_charge": 1169.36, "discounted_cash": 315.73, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS HOLDING SCREW AND PLATE MINI FRAGMENT FOR USE W/ MODULAR HND SYSINSTR", "code_information": [{"code": "347.985", "type": "CDM"}], "standard_charges": [{"gross_charge": 1147.41, "discounted_cash": 309.8, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS INSULATED ENDO RAT TOOTH 2.8MM X 1650MM X 14.9MM", "code_information": [{"code": "FG-47L-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1279.44, "discounted_cash": 345.45, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS MAGILL INTUBATION 8 MDS0419020F", "code_information": [{"code": "MDS0419020F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.13, "discounted_cash": 13.54, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS PLATE HOLDING 150MM W/ SWIVELFT FOR USE W/ MODULAR HND SYS", "code_information": [{"code": "398.819.96", "type": "CDM"}], "standard_charges": [{"gross_charge": 2516.31, "discounted_cash": 679.4, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS PLATE HOLDING SZ 0 W/ SWIVELFT FOR 2.7 MM AND 3.5 MM PLATES", "code_information": [{"code": "398.811", "type": "CDM"}], "standard_charges": [{"gross_charge": 2322.75, "discounted_cash": 627.14, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION 130MM W/ POINT RATCHET", "code_information": [{"code": "399.97", "type": "CDM"}], "standard_charges": [{"gross_charge": 793.16, "discounted_cash": 214.15, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION 132MM W/ POINT NARROW RATCHET", "code_information": [{"code": "398.4", "type": "CDM"}], "standard_charges": [{"gross_charge": 1627.11, "discounted_cash": 439.32, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION 140MM RATCHET W/ SERRATED JAW", "code_information": [{"code": "399.99", "type": "CDM"}], "standard_charges": [{"gross_charge": 1858.68, "discounted_cash": 501.84, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION 180MM SPEED LOCK", "code_information": [{"code": "399.06", "type": "CDM"}], "standard_charges": [{"gross_charge": 2389.73, "discounted_cash": 645.23, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION 205MM RATCHET W/ POINTS", "code_information": [{"code": "399.98", "type": "CDM"}], "standard_charges": [{"gross_charge": 2596.59, "discounted_cash": 701.08, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION 240MM SPEED LOCK W/ SERRATED JAW", "code_information": [{"code": "399.051", "type": "CDM"}], "standard_charges": [{"gross_charge": 2553.36, "discounted_cash": 689.41, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION SMINSTR", "code_information": [{"code": "IFI-491430", "type": "CDM"}], "standard_charges": [{"gross_charge": 1482.0, "discounted_cash": 400.14, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REDUCTION W/ POINT BROAD RATCHET", "code_information": [{"code": "398.41", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1627.11, "discounted_cash": 439.32, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS REMOVAL FOR BROKEN SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "398.65", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2508.0, "discounted_cash": 677.16, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS SCREW MINI FRAGMENT FOR SLF TAPPING SCREWINSTR", "code_information": [{"code": "319.97", "type": "CDM"}], "standard_charges": [{"gross_charge": 253.54, "discounted_cash": 68.46, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS TERMITE 90MM", "code_information": [{"code": "398.95", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 968.72, "discounted_cash": 261.55, "setting": "both", "billing_class": "facility"}]}, {"description": "FORCEPS TISSUE 9 X 9MM X 8IN SINGLE PILOT BROWN CTR INDIANA TOME", "code_information": [{"code": "200061", "type": "CDM"}], "standard_charges": [{"gross_charge": 1017.0, "discounted_cash": 274.59, "setting": "both", "billing_class": "facility"}]}, {"description": "FOREFOOT IMPLANT SYS PEEK AR-1530P-CP", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1530P-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4536.54, "discounted_cash": 1224.87, "setting": "both", "billing_class": "facility"}]}, {"description": "FOREHEAD FLAP W/VASC PEDICLE", "code_information": [{"code": "15731", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FORENSIC AUTOPSY (NECROPSY)", "code_information": [{"code": "88040", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 526.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FREE FLAP FORMATION 15570", "code_information": [{"code": "15570", "type": "CPT"}, {"code": "1480961", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "gross_charge": 7408.0, "discounted_cash": 2000.16, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47740", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE GALLBLADDER & BOWEL", "code_information": [{"code": "47741", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE LIVER DUCT & INTESTINE", "code_information": [{"code": "47802", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"description": "FUSE LIVER DUCTS & BOWEL", "code_information": [{"code": "47765", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSE PANCREAS AND BOWEL", "code_information": [{"code": "48548", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF KNUCKLE JOINTS", "code_information": [{"code": "26518", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF SKULL ARTERIES", "code_information": [{"code": "61711", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54900", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF SPERMATIC DUCTS", "code_information": [{"code": "54901", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF STOMACH AND BOWEL", "code_information": [{"code": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "FUSION OF URETER & KIDNEY", 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[{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 15.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROCNEMIUS RECESSION 27687", "code_information": [{"code": "27687", "type": "CPT"}, {"code": "1480981", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "gross_charge": 6172.0, "discounted_cash": 1666.44, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 4629.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": 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"standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL FAT ABSORPT", "code_information": [{"code": "S3708", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.0, "maximum": 1.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GASTROINTESTINAL REPAIR", "code_information": [{"code": "43360", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART MULTIPLE", "code_information": [{"code": "78473", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 383.8, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "GATED HEART PLANAR SINGLE", "code_information": [{"code": "78472", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 294.3, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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VANGUARD", "code_information": [{"code": "32-487214", "type": "CDM"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 648.0, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE BOLT LAT MALLORY HEAD", "code_information": [{"code": "31-108050", "type": "CDM"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 140.94, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH 2.7MM NLOCK OPTILOCK", "code_information": [{"code": "14-400763", "type": "CDM"}], "standard_charges": [{"gross_charge": 3303.0, "discounted_cash": 891.81, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH 3.5MM NLOCK OPTILOCK", "code_information": [{"code": "14-400764", "type": "CDM"}], "standard_charges": [{"gross_charge": 3303.0, "discounted_cash": 891.81, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH 50MM FOR 2MM SCREWINSTR", "code_information": [{"code": "IFI-491433", "type": "CDM"}], "standard_charges": [{"gross_charge": 3297.0, "discounted_cash": 890.19, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FLEXIBLE", "code_information": [{"code": "31-111114", "type": "CDM"}], "standard_charges": [{"gross_charge": 3732.0, "discounted_cash": 1007.64, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR 150MM WIRE", "code_information": [{"code": "MSN40001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2340.0, "discounted_cash": 631.8, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR 2 MM AND 2.4 MM CORTEX SCREWSINSTR", "code_information": [{"code": "319.006", "type": "CDM"}], "standard_charges": [{"gross_charge": 2158.16, "discounted_cash": 582.7, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR 2.7 MM AND SM SCREW", "code_information": [{"code": "319.01", "type": "CDM"}], "standard_charges": [{"gross_charge": 1564.37, "discounted_cash": 422.38, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR 200MM WIRE", "code_information": [{"code": "MSN40003", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2223.54, "discounted_cash": 600.36, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR LG SCREW", "code_information": [{"code": "319.1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2014.95, "discounted_cash": 544.04, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR MINI SCREW", "code_information": [{"code": "319.11", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1849.41, "discounted_cash": 499.34, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE DEPTH FOR SM SCREW", "code_information": [{"code": "319.09", "type": 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[{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 3MM XL UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420515", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 4MM TO 5MM LG UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420398", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 4MM TO 5MM MED UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420394", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 4MM TO 5MM UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420390", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 4MM TO 5MM XL UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420516", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 6MM TO 7MM LG UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420399", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 6MM TO 7MM MED GAP UNIVERSAL OXFORD", "code_information": [{"code": "32-420395", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 6MM TO 7MM SM GAP UNIVERSAL OXFORD", "code_information": [{"code": "32-420391", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 6MM TO 7MM XL UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420517", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 8MM TO 9MM LG UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420400", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 8MM TO 9MM MED UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420396", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 8MM TO 9MM SM GAP UNIVERSAL OXFORD", "code_information": [{"code": "32-420392", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER 8MM TO 9MM XL UNIVERSAL GAP OXFORD", "code_information": [{"code": "32-420518", "type": "CDM"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE FEELER PROXIMAL FEMORAL AXIAL ANT VANGAURD", "code_information": [{"code": "32-347594", "type": "CDM"}], "standard_charges": [{"gross_charge": 858.0, "discounted_cash": 231.66, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE GAP 1/2MM LG OXFORD", "code_information": [{"code": "32-422810", "type": "CDM"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE GAP 1/2MM MED OXFORD", "code_information": [{"code": "32-422805", "type": "CDM"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE GAP 1/2MM SM OXFORD", "code_information": [{"code": "32-422771", "type": "CDM"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 106.92, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE GAP 1/2MM XL OXFORD", "code_information": [{"code": "32-422815", "type": "CDM"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE GAP 3/4MM LG OXFORD", "code_information": [{"code": "32-422811", "type": "CDM"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 113.4, "setting": "both", "billing_class": "facility"}]}, {"description": "GAUGE GAP 3/4MM MED OXFORD", "code_information": [{"code": "32-422806", "type": "CDM"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 113.4, "setting": "both", "billing_class": 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"GRAZERBLADE STRYKER CONNECTION 7000-40GB", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7000-40GB", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 172.5, "discounted_cash": 46.58, "setting": "both", "billing_class": "facility"}]}, {"description": "GREAT TOE-HAND TRANSFER", "code_information": [{"code": "26551", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"RC"}], "standard_charges": [{"gross_charge": 741.0, "discounted_cash": 200.07, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE COUNTERSINK ORTHO SURG W/ MINI QUICK COUPLING FOR USE W/ TAPS COUNTERSINK", "code_information": [{"code": "311.01", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1472.04, "discounted_cash": 397.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE COUNTERSINK QUICK COUPLING T FOR USE W/ TAPS COUNTERSINKS AND SCREWDRIVER", "code_information": [{"code": "311.44", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1037.4, "discounted_cash": 280.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE DEV W/ MINI QUICK COUPLING SS", "code_information": [{"code": "310.95", "type": "CDM"}], "standard_charges": [{"gross_charge": 1410.75, "discounted_cash": 380.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE DRILL STRAIGHT COMPREHENSIVE", "code_information": [{"code": "31-111116", "type": "CDM"}], "standard_charges": [{"gross_charge": 3651.0, "discounted_cash": 985.77, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE DRIVE MINI W/ AO CONNECTION", "code_information": [{"code": "IFI-491459", "type": "CDM"}], "standard_charges": [{"gross_charge": 3120.0, "discounted_cash": 842.4, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE DRIVER AUGMENT NAIL REGENEREX", "code_information": [{"code": "31-177702", "type": "CDM"}], "standard_charges": [{"gross_charge": 4731.0, "discounted_cash": 1277.37, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE ENDO GIA 4 STANDARD EGIAUSTND", "code_information": [{"code": "EGIAUSTND", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1040.27, "discounted_cash": 280.87, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE EXTRACTOR ANT", "code_information": [{"code": "31-555528", "type": "CDM"}], "standard_charges": [{"gross_charge": 3864.0, "discounted_cash": 1043.28, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE EXTRACTOR IMPACT", "code_information": [{"code": "31-112197", "type": "CDM"}], "standard_charges": [{"gross_charge": 1827.0, "discounted_cash": 493.29, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE FEMORAL IMPACTOR EXTRACTOR ASCENT", "code_information": [{"code": "32-379652", "type": "CDM"}], "standard_charges": [{"gross_charge": 3591.0, "discounted_cash": 969.57, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE HUB BENDER MAX TI", "code_information": [{"code": "124190", "type": "CDM"}], "standard_charges": [{"gross_charge": 4884.0, "discounted_cash": 1318.68, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE IMPACT MODULAR VANGAURD 360", "code_information": [{"code": "32-360215", "type": "CDM"}], "standard_charges": [{"gross_charge": 6624.0, "discounted_cash": 1788.48, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE IMPACTION ARCOS", "code_information": [{"code": "31-301918", "type": "CDM"}], "standard_charges": [{"gross_charge": 2523.0, "discounted_cash": 681.21, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE INSERTER DUAL MOBILITY HIP SYS CURVED ACTIVE ARTICULATION M2A", "code_information": [{"code": "S313131", "type": "CDM"}], "standard_charges": [{"gross_charge": 8850.0, "discounted_cash": 2389.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE LARYNGOSCOPE DISPOSABLE MEDIUM SLH02", "code_information": [{"code": "SLH02", "type": "CDM"}], "standard_charges": [{"gross_charge": 36.08, "discounted_cash": 9.74, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE LARYNGOSCOPE FIBEROPTIC  SINGLE 77700", "code_information": [{"code": "77700", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.93, "discounted_cash": 14.02, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MODULAR .25IN TO 28IN TIP MINIMALLYINVASIVE HIP", "code_information": [{"code": "31-400604", "type": "CDM"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MODULAR .375IN TIP MINIMALLYINVASIVE HIP SPHERE", "code_information": [{"code": "31-400602", "type": "CDM"}], "standard_charges": [{"gross_charge": 474.0, "discounted_cash": 127.98, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MODULAR .375IN TIP MINIMALLYINVASIVE HIP SQUARE", "code_information": [{"code": "31-400601", "type": "CDM"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 157.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MODULAR ANT POST W/ SZR ATTCHMNT VANGUARD", "code_information": [{"code": "32-484061", "type": "CDM"}], "standard_charges": [{"gross_charge": 6828.0, "discounted_cash": 1843.56, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MODULAR CINCH ECHO", "code_information": [{"code": "31-555611", "type": "CDM"}], "standard_charges": [{"gross_charge": 5550.0, "discounted_cash": 1498.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE MODULAR VANGUARD", "code_information": [{"code": "32-484060", "type": "CDM"}], "standard_charges": [{"gross_charge": 7548.0, "discounted_cash": 2037.96, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE OFFSET LFT DUAL PARAGON", "code_information": [{"code": "31-555405", "type": "CDM"}], "standard_charges": [{"gross_charge": 20100.0, "discounted_cash": 5427.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE OFFSET RIGHT DUAL PARAGON", "code_information": [{"code": "31-555406", "type": "CDM"}], "standard_charges": [{"gross_charge": 20100.0, "discounted_cash": 5427.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE PROVISIONAL BI-POLAR", "code_information": [{"code": "31-479365", "type": "CDM"}], "standard_charges": [{"gross_charge": 1128.0, "discounted_cash": 304.56, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE PROVISIONAL MODULAR HEAD BIO-MOORE II", "code_information": [{"code": "31-482565", "type": "CDM"}], "standard_charges": [{"gross_charge": 609.0, "discounted_cash": 164.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE PUNCH FOR TIBL TRAY MICROPLASTY", "code_information": [{"code": "32-484511", "type": "CDM"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 424.44, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE PUNCH TIBL VANGUARD", "code_information": [{"code": "32-487272", "type": "CDM"}], "standard_charges": [{"gross_charge": 3564.0, "discounted_cash": 962.28, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE QC RATCHETING CANNULATED", "code_information": [{"code": "AR-8950RH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3233.75, "discounted_cash": 873.11, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE RASP 45 DEGREE STYLE B", "code_information": [{"code": "31-478042", "type": "CDM"}], "standard_charges": [{"gross_charge": 3834.0, "discounted_cash": 1035.18, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE RASP BROACH PUSH BTN STYLE AINSTR", "code_information": [{"code": "31-473700", "type": "CDM"}], "standard_charges": [{"gross_charge": 5028.0, "discounted_cash": 1357.56, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE RASP STANMORE", "code_information": [{"code": "31-416020", "type": "CDM"}], "standard_charges": [{"gross_charge": 5271.0, "discounted_cash": 1423.17, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE RATCHET MODULAR SCREWDRIVER", "code_information": [{"code": "31-424200", "type": "CDM"}], "standard_charges": [{"gross_charge": 5775.0, "discounted_cash": 1559.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE REAMER 1/2IN GLND", "code_information": [{"code": "406149", "type": "CDM"}], "standard_charges": [{"gross_charge": 2064.0, "discounted_cash": 557.28, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE REAMER EXACT EZ CLEAN", "code_information": [{"code": "31-111111", "type": "CDM"}], "standard_charges": [{"gross_charge": 6675.0, "discounted_cash": 1802.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE REAMER MODULAR GRATER SNAP ON", "code_information": [{"code": "31-475698", "type": "CDM"}], "standard_charges": [{"gross_charge": 5175.0, "discounted_cash": 1397.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE REMOVAL MODULAR HEAD", "code_information": [{"code": "31-473540", "type": "CDM"}], "standard_charges": [{"gross_charge": 3222.0, "discounted_cash": 869.94, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE STEMINSERTER ECHO BI-METRIC", "code_information": [{"code": "31-555619", "type": "CDM"}], "standard_charges": [{"gross_charge": 5598.0, "discounted_cash": 1511.46, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE SUCTION YANKAUER STRAIGHT OPEN TIP STRL DISP", "code_information": [{"code": "K87", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE T FEMORAL VANGUARD", "code_information": [{"code": "32-487040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE T REAMER CS2 ALLIANCE", "code_information": [{"code": "595552", "type": "CDM"}], "standard_charges": [{"gross_charge": 6579.0, "discounted_cash": 1776.33, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE T STANDARD", "code_information": [{"code": "31-473620", "type": "CDM"}], "standard_charges": [{"gross_charge": 2772.0, "discounted_cash": 748.44, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE T THREADED EXACT", "code_information": [{"code": "31-473191", "type": "CDM"}], "standard_charges": [{"gross_charge": 3861.0, "discounted_cash": 1042.47, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE T TORQUE LIMITING ARCOS", "code_information": [{"code": "31-301850", "type": "CDM"}], "standard_charges": [{"gross_charge": 10464.0, "discounted_cash": 2825.28, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE TEMPLATE FOR TIBL TRAY MICROPLASTY", "code_information": [{"code": "32-484510", "type": "CDM"}], "standard_charges": [{"gross_charge": 5436.0, "discounted_cash": 1467.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE TIBL TRIAL", "code_information": [{"code": "32-341259", "type": "CDM"}], "standard_charges": [{"gross_charge": 2736.0, "discounted_cash": 738.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLE TRIAL SHELL", "code_information": [{"code": "31-177901", "type": "CDM"}], "standard_charges": [{"gross_charge": 4224.0, "discounted_cash": 1140.48, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSERTER 3/8IN STRAIGHT TIBL SYS VANGUARD MONOBLOCK", "code_information": [{"code": "S313151", "type": "CDM"}], "standard_charges": [{"gross_charge": 7926.0, "discounted_cash": 2140.02, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSERTER ACTBLR STRAIGHT DUAL MOBILITY HIP SYS ACTIVE ARTICULATION", "code_information": [{"code": "S313141", "type": "CDM"}], "standard_charges": [{"gross_charge": 6132.0, "discounted_cash": 1655.64, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSERTER MINIMALLYINVASIVE HIP CUP MODULAR", "code_information": [{"code": "31-400600", "type": "CDM"}], "standard_charges": [{"gross_charge": 11235.0, "discounted_cash": 3033.45, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSERTER OFFSET MICROPLASTY", "code_information": [{"code": "31-555525", "type": "CDM"}], "standard_charges": [{"gross_charge": 3552.0, "discounted_cash": 959.04, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSERTER PININSERTER HANDLE COMPRESS", "code_information": [{"code": "32-481030", "type": "CDM"}], "standard_charges": [{"gross_charge": 2193.0, "discounted_cash": 592.11, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSTR ANTI ROTATION ARCOS", "code_information": [{"code": "31-301870", "type": "CDM"}], "standard_charges": [{"gross_charge": 3396.0, "discounted_cash": 916.92, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSTR DRILL GUIDE ACTBLR PRECEPT", "code_information": [{"code": "31-000000", "type": "CDM"}], "standard_charges": [{"gross_charge": 2808.0, "discounted_cash": 758.16, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSTR ENDO BALL NOSE BIPOLAR CINCH", "code_information": [{"code": "31-401169", "type": "CDM"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDLEINSTR FOR STANDARD AND LNG TAPER ADAPTOR REAMER RAMP", "code_information": [{"code": "31-473507", "type": "CDM"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 182.25, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE ABLATION ENDO MINERVA", "code_information": [{"code": "MIN3PAK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 789.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE ABLATION ENDOMETRIAL MINERVA", "code_information": [{"code": "MIN9770", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2925.0, "discounted_cash": 789.75, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDPIECE TIP ULTRA-DRIVE 7.0MM 423923", "code_information": [{"code": "423923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2205.0, "discounted_cash": 595.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HANDSET HH9020SCS", "code_information": [{"code": "HH9020SCS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3168.75, "discounted_cash": 855.56, "setting": "both", "billing_class": "facility"}]}, {"description": "HARNESS HEAD ADULT DISPOSABLE LF 4-1054-23", "code_information": [{"code": "4-1054-23", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.18, "discounted_cash": 12.74, "setting": "both", "billing_class": "facility"}]}, {"description": "HARVEST ALLOGENEIC STEM CELL", "code_information": [{"code": "38205", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST AUTO STEM CELLS", "code_information": [{"code": "38206", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HARVEST CULTURED SKIN GRAFT", "code_information": [{"code": "15040", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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S ROM", "code_information": [{"code": "136534000", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM PLUS 5.0MM BIOLOX DELTA CERAMIC C TAPER ULTRA HIGH", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "18-3605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7084.8, "discounted_cash": 1912.9, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM PLUS 6 NECK BIOLOX DELTA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "12-115123", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10536.0, "discounted_cash": 2844.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MM STANDARD NECK BIOLOX DELTA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "12-115121", "type": 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"standard_charges": [{"gross_charge": 9622.8, "discounted_cash": 2598.16, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 36MMX 6MM ACTBLR SYS TYPE 1 COCR G7", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "11-363660", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1632.0, "discounted_cash": 440.64, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 38MM MINUS 3 NECK BIOLOX DELTA", "code_information": [{"code": "12-115131", "type": "CDM"}], "standard_charges": [{"gross_charge": 10536.0, "discounted_cash": 2844.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 38MM MINUS 6 NECK BIOLOX DELTA", "code_information": [{"code": "12-115130", "type": "CDM"}], "standard_charges": [{"gross_charge": 10536.0, "discounted_cash": 2844.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 38MM STANDARD NECK BIOLOX DELTA", "code_information": [{"code": "12-115132", "type": "CDM"}], "standard_charges": [{"gross_charge": 10536.0, "discounted_cash": 2844.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40.0MM CERAMIC BIOLOXD OPTION", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "650-1058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4383.0, "discounted_cash": 1183.41, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40MM OFFSET 1.5MM DELTA CERAMIC 12 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-40-710", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7464.6, "discounted_cash": 2015.44, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 40MM OFFSET 12MM DELTA CERAMIC 12 14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "136540740", "type": "CDM"}, 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FEMORAL 44MM OFFSET 1.5MM DELTA CERAMIC 12 14", "code_information": [{"code": "136544710", "type": "CDM"}], "standard_charges": [{"gross_charge": 7267.65, "discounted_cash": 1962.27, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 44MM OFFSET 5MM DELTA CERAMIC 12 14", "code_information": [{"code": "136544720", "type": "CDM"}], "standard_charges": [{"gross_charge": 7267.65, "discounted_cash": 1962.27, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 44MM TAPER UNIVERSAL CERAMIC BIOLOX DELTA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6519-1-044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5346.6, "discounted_cash": 1443.58, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 44MM X 15MM ECCENTRIC EPIPHYSIS GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110044600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 44MM X 18MM ECCENTRIC EPIPHYSIS GLOBAL UNITE", "code_information": [{"code": "110044610", "type": "CDM"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 44MM X 21MM ECCENTRIC EPIPHYSIS GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110044620", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 48MM X 15MM ECCENTRIC EPIPHYSIS GLOBAL UNITE", "code_information": [{"code": "110048600", "type": "CDM"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 48MM X 15MM STANDARD GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110048500", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 48MM X 18MM ECCENTRIC EPIPHYSIS GLOBAL UNITE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "110048610", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 48MM X 18MM STANDARD GLOBAL UNITE", "code_information": [{"code": "110048510", "type": "CDM"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 48MM X 21MM ECCENTRIC EPIPHYSIS GLOBAL UNITE", "code_information": [{"code": "110048620", "type": "CDM"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 48MM X 21MM STANDARD GLOBAL UNITE", "code_information": [{"code": "110048520", "type": "CDM"}], "standard_charges": [{"gross_charge": 4027.5, "discounted_cash": 1087.43, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 50MM STEM BIRMINGHAM HIP IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74121150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8880.0, "discounted_cash": 2397.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL 56MM +5MM 12/14 TAPER IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1965-52-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL ARTICUL/EZE M-SPEC 40MM+15.5 12/14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-09-000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL BIOLOX DELTA 38MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-14-310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL CERAMIC BIOLOX TAPER 12/14 32MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-8775-032-02", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2205.0, "discounted_cash": 595.35, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL DELTA 36MM BIOLOX", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5010.42.362", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 526.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL HIP 28MM +4 OFFSET BIOLOX DELTA V40", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6570-0-228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1767.0, "discounted_cash": 477.09, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL HIP 52MM BIRMINGHAM RESURFACING COBALT CHROME", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "74123152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9562.5, "discounted_cash": 2581.88, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL MEDIUM TAPER/CONO 12/14", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5010.42.282", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 526.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL NEGATIVE 4MM OFFSET 28MM DIA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6260-9-028", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1767.0, "discounted_cash": 477.09, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL OFFET DELTA CERAMIC 12/14 9MM X 32MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1365-32-730", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL PRIMARY IMPACTOR EXTRACTOR ASCENT", "code_information": [{"code": "32-379650", "type": "CDM"}], "standard_charges": [{"gross_charge": 5094.0, "discounted_cash": 1375.38, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMORAL X LONG TAPER 36 MM LIMA", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5010.42.364", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 526.5, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMRL 28MM +5MM NEUTRAL CEMENTED COLLARED PROXIMAL WEDGE COBALTH CHROME IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7-1-2803", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMRL 36MM OFFSET +5MM CONTOURED MTL ASPHERE M SPEC ARTOCUL ELZE 12/14 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "136552100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD FEMROAL 44MM OFFSET 12MM DELTA CERAMIC 12 14", "code_information": [{"code": "136544740", "type": "CDM"}], "standard_charges": [{"gross_charge": 7267.65, "discounted_cash": 1962.27, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD GLENOID 36MM W/ NEUTRAL SCREW", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "508-36-101", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HEMI MPJ METATARSAL CHROME ROUND 16.0 COBALT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CMHI-16", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14060.7, "discounted_cash": 3796.39, "setting": 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1161.54, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HIP MOLD 64MM", "code_information": [{"code": "431185", "type": "CDM"}], "standard_charges": [{"gross_charge": 4302.0, "discounted_cash": 1161.54, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL   42X18 LOW OFFSET ASCEND FLEX STB DWG044", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8881.5, "discounted_cash": 2398.01, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL   45X19 LOW OFFSET ASCEND FLEX STB DWG047", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "HEAD HUMERAL   48 X 21 ECCENTRIC 0020030", 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"standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALEY FLANGED TRL GAUGE SZ 60MM", "code_information": [{"code": "429560", "type": "CDM"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALEY FLANGED TRL GAUGE SZ 62MM", "code_information": [{"code": "429562", "type": "CDM"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALEY FLANGED TRL GAUGE SZ 64MM", "code_information": [{"code": "429564", "type": "CDM"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALEY FLANGED TRL GAUGE SZ 66MM", "code_information": [{"code": "429566", "type": "CDM"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALEY FLANGED TRL GAUGE SZ 68MM", "code_information": [{"code": "429568", "type": "CDM"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALEY FLANGED TRL GAUGE SZ 70MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "429570", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1680.0, "discounted_cash": 453.6, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALICOIL RG DILATOR 4.75MM DISPOSABLE", "code_information": [{"code": "72203951", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 157.95, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALIX ADVANCE W DYNACORD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "222005", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1260.0, "discounted_cash": 340.2, "setting": "both", "billing_class": "facility"}]}, {"description": "HEALON 10MG/ML 0.4ML", "code_information": [{"code": "MED0550", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 317.76, "discounted_cash": 85.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HEARING AID CHECK BOTH EARS", "code_information": [{"code": "92593", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID CHECK ONE EAR", "code_information": [{"code": "92592", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM BOTH EARS", "code_information": [{"code": "92591", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING AID EXAM ONE EAR", "code_information": [{"code": "92590", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS DUP/DEL ANALYS", "code_information": [{"code": "81431", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 611.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEARING LOSS SEQUENCE ANALYS", "code_information": [{"code": "81430", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1462.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS ADD-ON", "code_information": [{"code": "78496", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 101.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS MULTIPLE", "code_information": [{"code": "78483", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 326.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FIRST PASS SINGLE", "code_information": [{"code": "78481", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 239.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93571", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART FLOW RESERVE MEASURE", "code_information": [{"code": "93572", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART IMAGE SPECT", "code_information": [{"code": "78494", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 307.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE", "code_information": [{"code": "78466", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 206.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (3D)", "code_information": [{"code": "78469", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 296.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART INFARCT IMAGE (EF)", "code_information": [{"code": "78468", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 259.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEART PACING MAPPING", "code_information": [{"code": "93631", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8242.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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[{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HEPATITIS BE ANTIBODY", "code_information": [{"code": "86707", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.41, "methodology": "fee 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"standard_charges": [{"gross_charge": 4295.4, "discounted_cash": 1159.76, "setting": "both", "billing_class": "facility"}]}, {"description": "HYLENEX 150U/ML 1ML", "code_information": [{"code": "MED0569", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 141.1, "discounted_cash": 38.1, "setting": "both", "billing_class": "facility"}]}, {"description": "HYMENOTOMY", "code_information": [{"code": "56442", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOID MYOTOMY & SUSPENSION", "code_information": [{"code": "21685", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYOSCYAMINE 0.5 MG/ML INJ SOL", "code_information": [{"code": "MED0691", "type": "CDM"}], "standard_charges": [{"gross_charge": 173.32, "discounted_cash": 46.8, "setting": "both", "billing_class": "facility"}]}, {"description": "HYPERBARIC OXYGEN THERAPY", "code_information": [{"code": "99183", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERBLADE HLSH .054X25.4X95", "code_information": [{"code": "516029", "type": "CDM"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "HYPERBLADE SSH .047X25.4X95", "code_information": [{"code": "516027", "type": "CDM"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "HYPERBLADE SSH .054X25.4X95", "code_information": [{"code": "516025", "type": "CDM"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77600", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 458.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77605", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 996.47, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77610", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 834.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77615", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1213.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTHERMIA TREATMENT", "code_information": [{"code": "77620", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 519.27, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPERTONIC SALINE 10% 10ML", "code_information": [{"code": "MED0573", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 54.5, "discounted_cash": 14.72, "setting": "both", "billing_class": "facility"}]}, {"description": "HYPNOTHERAPY", "code_information": [{"code": "90880", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPOTHERMIA ILL NEONATE", "code_information": [{"code": "99184", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYPOXIA RESPONSE CURVE", "code_information": [{"code": "94450", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/BLADDER REPAIR", "code_information": [{"code": "51925", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HYSTERECTOMY/REVISE VAGINA", "code_information": [{"code": "58275", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 3100.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ILIAC REVASC W/STENT ADD-ON", "code_information": [{"code": "37223", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN 1ST/ONLY COMPONENT", "code_information": [{"code": "90460", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM ADMIN EACH ADDL COMPONENT", "code_information": [{"code": "90461", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER CMPL", "code_information": [{"code": "263T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER HRVST ONL", "code_information": [{"code": "265T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM B1 MRW CEL THER XCL HRVST", "code_information": [{"code": "264T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IM BONE SAW ADJUSTING SLEEVE", "code_information": [{"code": "475617", "type": "CDM"}], "standard_charges": [{"gross_charge": 837.0, "discounted_cash": 225.99, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW CAM ASBLY 12MM", "code_information": [{"code": "475655", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW CAM ASBLY 13MM", "code_information": [{"code": "475660", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW CAM ASBLY 14MM", "code_information": [{"code": "475665", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW CAM ASBLY 15MM", "code_information": [{"code": "475670", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW CAM ASBLY 16MM", "code_information": [{"code": "475675", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW CAM ASBLY 17MM", "code_information": [{"code": "475680", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW HAND GUIDE", "code_information": [{"code": "475614", "type": "CDM"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW INDEXING PLUNGER", "code_information": [{"code": "475615", "type": "CDM"}], "standard_charges": [{"gross_charge": 987.0, "discounted_cash": 266.49, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAW LOCKING PLUNGER", "code_information": [{"code": "475616", "type": "CDM"}], "standard_charges": [{"gross_charge": 1077.0, "discounted_cash": 290.79, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAWBLADE ASBLY 12MM", "code_information": [{"code": "475620", "type": "CDM"}], "standard_charges": [{"gross_charge": 2331.0, "discounted_cash": 629.37, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAWBLADE ASBLY 13MM", "code_information": [{"code": "475625", "type": "CDM"}], "standard_charges": [{"gross_charge": 2331.0, "discounted_cash": 629.37, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAWBLADE ASBLY 14MM", "code_information": [{"code": "475630", "type": "CDM"}], "standard_charges": [{"gross_charge": 2331.0, "discounted_cash": 629.37, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAWBLADE ASBLY 15MM", "code_information": [{"code": "475635", "type": "CDM"}], "standard_charges": [{"gross_charge": 2331.0, "discounted_cash": 629.37, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAWBLADE ASBLY 16MM", "code_information": [{"code": "475640", "type": "CDM"}], "standard_charges": [{"gross_charge": 2331.0, "discounted_cash": 629.37, "setting": "both", "billing_class": "facility"}]}, {"description": "IM BONE SAWBLADE ASBLY 17MM", "code_information": [{"code": "475645", "type": "CDM"}], "standard_charges": [{"gross_charge": 2331.0, "discounted_cash": 629.37, "setting": "both", "billing_class": "facility"}]}, {"description": "IM INTERNAL CHISEL 12-13MM", "code_information": [{"code": "475720", "type": "CDM"}], "standard_charges": [{"gross_charge": 4092.0, "discounted_cash": 1104.84, "setting": "both", "billing_class": "facility"}]}, {"description": "IM INTERNAL CHISEL 14-15MM", "code_information": [{"code": "475725", "type": "CDM"}], "standard_charges": [{"gross_charge": 4506.0, "discounted_cash": 1216.62, "setting": "both", "billing_class": "facility"}]}, {"description": "IM INTERNAL CHISEL 16-17MM", "code_information": [{"code": "475730", "type": "CDM"}], "standard_charges": [{"gross_charge": 4923.0, "discounted_cash": 1329.21, "setting": "both", "billing_class": "facility"}]}, {"description": "IM RADIAL RESECTION GUIDE", "code_information": [{"code": "409003", "type": "CDM"}], "standard_charges": [{"gross_charge": 2346.0, "discounted_cash": 633.42, "setting": "both", "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID COLXN VISC", "code_information": [{"code": "49405", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMAGE CATH FLUID PERI/RETRO", "code_information": [{"code": "49406", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": 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"discounted_cash": 136.08, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR BALL 58MM CUP M2A MAGNUM", "code_information": [{"code": "31-141085", "type": "CDM"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 136.08, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR BALL 60MM CUP M2A MAGNUM", "code_information": [{"code": "31-141087", "type": "CDM"}], "standard_charges": [{"gross_charge": 504.0, "discounted_cash": 136.08, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR BONE FEMORAL TIBL VANGUARD", "code_information": [{"code": "32-486201", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR BOX POST VANGUARD", "code_information": [{"code": "32-486204", "type": "CDM"}], "standard_charges": [{"gross_charge": 3393.0, "discounted_cash": 916.11, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR CAGE PROTRUSIO", "code_information": [{"code": "31-109403", "type": "CDM"}], "standard_charges": [{"gross_charge": 1113.0, "discounted_cash": 300.51, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR CONTROL VANGUARD", "code_information": [{"code": "32-486209", "type": "CDM"}], "standard_charges": [{"gross_charge": 6987.0, "discounted_cash": 1886.49, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR FEMORAL CRUCIATE RETAINING ASCENT", "code_information": [{"code": "RD140617", "type": "CDM"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 648.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR FEMORAL CRUCIATE RETAINING MAXINSTR", "code_information": [{"code": "RD140017", "type": "CDM"}], "standard_charges": [{"gross_charge": 5181.0, "discounted_cash": 1398.87, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR FEMORAL POLYETHYLENE MAXIM", "code_information": [{"code": "32-347901", "type": "CDM"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 146.61, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR FEMORAL UNIVERSAL OXFORD", "code_information": [{"code": "32-420127", "type": "CDM"}], "standard_charges": [{"gross_charge": 1344.0, "discounted_cash": 362.88, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR FEMORAL VANGUARD DA 360", "code_information": [{"code": "32-422925", "type": "CDM"}], "standard_charges": [{"gross_charge": 2766.0, "discounted_cash": 746.82, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR HANDLE DIAPHYSEAL STEM TAPER IMPACTOR HANDLE OSS", "code_information": [{"code": "CP460471", "type": "CDM"}], "standard_charges": [{"gross_charge": 3048.0, "discounted_cash": 822.96, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR HEAD 36MM FREEDOM", "code_information": [{"code": "31-107036", "type": "CDM"}], "standard_charges": [{"gross_charge": 2025.0, "discounted_cash": 546.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR HEAD ACTIVE ARTICULATION", "code_information": [{"code": "31-139270", "type": "CDM"}], "standard_charges": [{"gross_charge": 1119.0, "discounted_cash": 302.13, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR HEAD FEMORAL", "code_information": [{"code": "31-476948", "type": "CDM"}], "standard_charges": [{"gross_charge": 990.0, "discounted_cash": 267.3, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR IMPLANT FEMORAL TIBL POLYETHYLENE HEAD FINN", "code_information": [{"code": "32-347906", "type": "CDM"}], "standard_charges": [{"gross_charge": 744.0, "discounted_cash": 200.88, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR KNEE PROXIMAL FEMORAL VANGAURD", "code_information": [{"code": "32-347592", "type": "CDM"}], "standard_charges": [{"gross_charge": 1578.0, "discounted_cash": 426.06, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR LINER 28MM FOR MODULAR HANDLE", "code_information": [{"code": "31-111128", "type": "CDM"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR LINER 32MM", "code_information": [{"code": "31-111132", "type": "CDM"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR LINER 36MM", "code_information": [{"code": "31-111136", "type": "CDM"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR LINER 38MM", "code_information": [{"code": "31-111138", "type": "CDM"}], "standard_charges": [{"gross_charge": 1125.0, "discounted_cash": 303.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR LINER 40MM", "code_information": [{"code": "31-111140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1218.75, "discounted_cash": 329.06, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR MODULAR HANDLE MAXIM", "code_information": [{"code": "32-347909", "type": "CDM"}], "standard_charges": [{"gross_charge": 4449.0, "discounted_cash": 1201.23, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR PLATE", "code_information": [{"code": "35-463110", "type": "CDM"}], "standard_charges": [{"gross_charge": 1356.0, "discounted_cash": 366.12, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR SCREWINTERMEDIATE VAR ANGLE HIP SCREW", "code_information": [{"code": "35-463216", "type": "CDM"}], "standard_charges": [{"gross_charge": 1173.0, "discounted_cash": 316.71, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR SLEEVE CENTERING SLEEVE IMPACTOR COMPRESS", "code_information": [{"code": "32-481029", "type": "CDM"}], "standard_charges": [{"gross_charge": 516.0, "discounted_cash": 139.32, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR STEM BIO-MOORE II", "code_information": [{"code": "31-482465", "type": "CDM"}], "standard_charges": [{"gross_charge": 2004.0, "discounted_cash": 541.08, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR TIBL ASCENT", "code_information": [{"code": "32-379970", "type": "CDM"}], "standard_charges": [{"gross_charge": 7557.0, "discounted_cash": 2040.39, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR TIBL END PLASTIC OXFORD", "code_information": [{"code": "32-420933", "type": "CDM"}], "standard_charges": [{"gross_charge": 852.0, "discounted_cash": 230.04, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR TIBL OXFORD", "code_information": [{"code": "32-420932", "type": "CDM"}], "standard_charges": [{"gross_charge": 6132.0, "discounted_cash": 1655.64, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR TIBL PLATE POLYETHYLENE MAXIM", "code_information": [{"code": "32-347902", "type": "CDM"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 146.61, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR TIBL POLYETHYLENE MAXIM", "code_information": [{"code": "32-347903", "type": "CDM"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 146.61, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR TIBL POLYETHYLENE VANGUARD", "code_information": [{"code": "32-486202", "type": "CDM"}], "standard_charges": [{"gross_charge": 5100.0, "discounted_cash": 1377.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPACTOR UNIVERSAL POLYETHYLENE MAXIM", "code_information": [{"code": "32-347904", "type": "CDM"}], "standard_charges": [{"gross_charge": 543.0, "discounted_cash": 146.61, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL ABSRB MSH/PRSTH DLY CLS", "code_information": [{"code": "15778", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPL BONE 3.2 X 3.5MM HAMMERTOE MIDDLE FINGER PROXIMAL SML JOINT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NX-3532MP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1968.0, "discounted_cash": 531.36, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPL FEMUR RIGHT SZ4 PRESSFIT PS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5516-F-402", "type": "CDM"}, 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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{"description": "IMPLANT HIP 40MM X 56MM PINNACLE", "code_information": [{"code": "121887456", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP 40MM X 58MM PINNACLE", "code_information": [{"code": "121887458", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP 40MM X 60MM PINNACLE", "code_information": [{"code": "121887460", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP 44MM X 64MM PINNACLE", "code_information": [{"code": "121887464", "type": "CDM"}], "standard_charges": [{"gross_charge": 4800.0, "discounted_cash": 1296.0, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP 44MM X 66MM PINNACLE", 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7125.0, "discounted_cash": 1923.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP STEM ACCOLADE SZ 6 35MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6721-0635", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5272.5, "discounted_cash": 1423.58, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 10 HIGH OFFSET COLLARLESS HIP SYS CORAIL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "L20310", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7125.0, "discounted_cash": 1923.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 11 HIGH OFFSET COLLARLESS HIP SYS CORAIL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "L20311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7125.0, "discounted_cash": 1923.75, 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"billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 15 HIGH OFFSET COLLARLESS HIP SYS CORAIL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "L20315", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7125.0, "discounted_cash": 1923.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 16 HIGH OFFSET COLLARLESS HIP SYS CORAIL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "L20316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7125.0, "discounted_cash": 1923.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 18 HIGH OFFSET COLLARLESS HIP SYS CORAIL", "code_information": [{"code": "L20318", "type": "CDM"}], "standard_charges": [{"gross_charge": 7125.0, "discounted_cash": 1923.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 2 180MM ENDURANCE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "152121000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14461.2, "discounted_cash": 3904.52, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 2 230MM ENDURANCE", "code_information": [{"code": "152124000", "type": "CDM"}], "standard_charges": [{"gross_charge": 14461.2, "discounted_cash": 3904.52, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 2 HI OFFSET ORTHO SURG WARSAW TRI-LOCK BPS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "101214020", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7125.0, "discounted_cash": 1923.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 20 D 60 D X 18 ID ENDURANCE", "code_information": [{"code": "122360000", "type": "CDM"}], "standard_charges": [{"gross_charge": 2640.3, "discounted_cash": 712.88, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 20 HIGH OFFSET COLLARLESS HIP SYS CORAIL", "code_information": [{"code": "L20320", "type": "CDM"}], "standard_charges": [{"gross_charge": 7125.0, "discounted_cash": 1923.75, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 250MM BOW RIGHT ENDURANCE", "code_information": [{"code": "152171000", "type": "CDM"}], "standard_charges": [{"gross_charge": 15036.45, "discounted_cash": 4059.84, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 3 145MM CALCAR ENDURANCE", "code_information": [{"code": "152161000", "type": "CDM"}], "standard_charges": [{"gross_charge": 16537.95, "discounted_cash": 4465.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 3 190MM ENDURANCE", "code_information": [{"code": "152122000", "type": "CDM"}], "standard_charges": [{"gross_charge": 14461.2, "discounted_cash": 3904.52, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 3 200MM CALCAR ENDURANCE", "code_information": [{"code": "152162000", "type": "CDM"}], "standard_charges": [{"gross_charge": 16537.95, "discounted_cash": 4465.25, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 3 240MM ENDURANCE", "code_information": [{"code": "152125000", "type": "CDM"}], "standard_charges": [{"gross_charge": 14461.2, "discounted_cash": 3904.52, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 3 250MM BOW LFT ENDURANCE", "code_information": [{"code": "152172000", "type": "CDM"}], "standard_charges": [{"gross_charge": 15036.45, "discounted_cash": 4059.84, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 3 300MM BOW LFT ENDURANCE", "code_information": [{"code": "152174000", "type": "CDM"}], "standard_charges": [{"gross_charge": 15036.45, "discounted_cash": 4059.84, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 3 300MM BOW RIGHT ENDURANCE", "code_information": [{"code": "152173000", "type": "CDM"}], "standard_charges": [{"gross_charge": 15036.45, "discounted_cash": 4059.84, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 3300MM ENDURANCE", "code_information": [{"code": "152127000", "type": "CDM"}], "standard_charges": [{"gross_charge": 14461.2, "discounted_cash": 3904.52, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 4 200MM ENDURANCE", "code_information": [{"code": "152123000", "type": "CDM"}], "standard_charges": [{"gross_charge": 14461.2, "discounted_cash": 3904.52, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLANT HIP SZ 4 250MM ENDURANCE", "code_information": [{"code": "152126000", "type": "CDM"}], "standard_charges": [{"gross_charge": 14461.2, "discounted_cash": 3904.52, "setting": "both", 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"standard_charges": [{"gross_charge": 283.22, "discounted_cash": 76.47, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLATE REAMER 5  METACARPAL  5.0MM X 87MM IMP-WAN-MR5", "code_information": [{"code": "IMP-WAN-MR5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 482.8, "discounted_cash": 130.36, "setting": "both", "billing_class": "facility"}]}, {"description": "IMPLT BRAIN CHEMOTX ADD-ON", "code_information": [{"code": "61517", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLT/RPL CRTD SNS 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ SYNTH RNFCMT ABDL WAL", "code_information": [{"code": "437T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IMPLTJ TOT RPLCMT HRT SYS", "code_information": [{"code": "33927", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "IN-HOSPITAL ON CALL SERVICE", "code_information": [{"code": "99026", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INACTIVATED JE VACC IM", "code_information": [{"code": "90738", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG LUMBAR", "code_information": [{"code": "22214", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS 1 VERTEBRAL SEG THORAC", "code_information": [{"code": "22212", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN ADL SEG", "code_information": [{"code": "22208", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCIS SPINE 3 COLUMN LUMBAR", "code_information": [{"code": "22207", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE BLADDER/DRAIN URETER", "code_information": 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"maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE INNER EYE ADHESIONS", "code_information": [{"code": "65865", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL (PRESS RELIEF)", "code_information": [{"code": "61343", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61458", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR BRAIN WOUND", "code_information": [{"code": "61571", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61450", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL FOR SURGERY", "code_information": [{"code": "61460", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SKULL/BRAIN SURGERY", "code_information": [{"code": "61735", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, 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1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPERM DUCT POUCH", "code_information": [{"code": "55605", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINAL CORD TRACT(S)", "code_information": [{"code": "63170", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE ACCESSORY NERVE", "code_information": [{"code": "63191", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE SPINE NRV >2 SEGMNTS", "code_information": [{"code": "63190", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE TEAR DUCT OPENING", "code_information": [{"code": "68440", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE TENDON(S) & MUSCLE(S)", "code_information": [{"code": "23406", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN EYELID LINING", "code_information": [{"code": "68020", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISE/DRAIN TEAR GLAND", "code_information": [{"code": "68400", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF BURN SCAB INITI", "code_information": [{"code": "16035", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF CHEEK NERVE", "code_information": [{"code": "64734", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF COLLARBONE JOINT", "code_information": [{"code": "23106", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EARDRUM", "code_information": [{"code": "69421", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF ESOPHAGUS", "code_information": [{"code": "43045", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF EYELID", "code_information": [{"code": "67710", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47480", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF GALLBLADDER", "code_information": [{"code": "47490", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33020", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HEART SAC", "code_information": [{"code": "33025", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONE", "code_information": [{"code": "27146", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP BONES", "code_information": [{"code": "27151", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF HIP TENDON", "code_information": [{"code": "27003", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF JAW NERVE", "code_information": [{"code": "64738", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LARGE BOWEL", "code_information": [{"code": "44025", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LINGUAL FRENUM 41010", "code_information": [{"code": "41010", "type": "CPT"}, {"code": "10956178", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 4243.0, "discounted_cash": 1145.61, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3182.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LIP FOLD", "code_information": [{"code": "40806", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF LYMPH CHANNELS", "code_information": [{"code": "38308", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF NECK OF FEMUR", "code_information": [{"code": "27161", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF PROSTATE", "code_information": [{"code": "52450", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF PYLORIC MUSCLE", "code_information": [{"code": "43520", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF SMALL BOWEL", "code_information": [{"code": "44010", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF SPERM DUCT", "code_information": [{"code": "55200", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH", "code_information": [{"code": "27448", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDON", "code_information": [{"code": "27390", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF THIGH TENDONS", "code_information": [{"code": "27391", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF URETHRA", "code_information": [{"code": "53020", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", "code_information": [{"code": "31600", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INCISION OF WINDPIPE", 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"CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INF/SUP DRILL-SCR GD", "code_information": [{"code": "405882", "type": "CDM"}], "standard_charges": [{"gross_charge": 9108.0, "discounted_cash": 2459.16, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLATION DEVICE Disposable Balloon Inflation Device  60 ml with lock 131-4493", "code_information": [{"code": "DB25011", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 88.84, "discounted_cash": 23.99, "setting": "both", "billing_class": "facility"}]}, {"description": "INFLUENZA A AG IF", "code_information": [{"code": "87276", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 14.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA A/B EACH AG IA", "code_information": [{"code": "87400", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 12.72, "methodology": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 11.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB 1+", "code_information": [{"code": "87501", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 46.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFLUENZA DNA AMP PROB ADDL", "code_information": [{"code": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INFUSOR PRESSURE 1000CC IN900012", "code_information": [{"code": "IN900012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.31, "discounted_cash": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 2304.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION EXT VENOGRAPHY", "code_information": [{"code": "36005", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", 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total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR BLADDER X-RAY", "code_information": [{"code": "51610", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECTION FOR CHOLANGIOGRAM", "code_information": [{"code": "47532", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"INSERT BEARING 28/74 10DEG ECCENTRIC IMP", "code_information": [{"code": "S-2301-2874", "type": "CDM"}], "standard_charges": [{"gross_charge": 2801.4, "discounted_cash": 756.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING 28/74 20DEG ECCENTRIC IMP", "code_information": [{"code": "S-2302-2874", "type": "CDM"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING 32/50-52 10DEG ECCENTRIC IMP", "code_information": [{"code": "S-2301-3250", "type": "CDM"}], "standard_charges": [{"gross_charge": 2801.4, "discounted_cash": 756.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING 32/50-52 20DEG ECCENTRIC IMP", "code_information": [{"code": "S-2302-3250", "type": "CDM"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING 32/52 10DEG ECCENTRIC IMP", "code_information": [{"code": "S-2301-3252", "type": "CDM"}], "standard_charges": [{"gross_charge": 2801.4, "discounted_cash": 756.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING 32/52 20DEG ECCENTRIC IMP", "code_information": [{"code": "S-2302-3252", "type": "CDM"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING 32/54-56 10DEG ECCENTRIC IMP", "code_information": [{"code": "S-2301-3254", "type": "CDM"}], "standard_charges": [{"gross_charge": 2801.4, "discounted_cash": 756.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING 32/54-56 20DEG ECCENTRIC IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "S-2302-3254", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2460.0, "discounted_cash": 664.2, "setting": "both", 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NRG", "code_information": [{"code": "82-3-1124", "type": "CDM"}], "standard_charges": [{"gross_charge": 2610.0, "discounted_cash": 704.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING NUMBER 11 8MM TIBL POSTERIORLY STABILIZED SCORPIO NRG", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "82-3-1108", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1587.0, "discounted_cash": 428.49, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING NUMBER 9 21MM TIBL POSTERIORLY STABILIZED SCORPIO NRG", "code_information": [{"code": "82-3-0921", "type": "CDM"}], "standard_charges": [{"gross_charge": 2610.0, "discounted_cash": 704.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING NUMBER 9 24MM TIBL POSTERIORLY STABILIZED SCORPIO NRG", "code_information": [{"code": "82-3-0924", "type": "CDM"}], "standard_charges": [{"gross_charge": 2610.0, "discounted_cash": 704.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING SZ 2 11MM TIBIAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5530-G-211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3510.0, "discounted_cash": 947.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING SZ 2 11MM TIBL POST TRIATHLON X3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-211", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3510.0, "discounted_cash": 947.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT BEARING SZ 2 19MM TIBL POST TRAITHLON X3 IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4200.0, "discounted_cash": 1134.0, "setting": "both", 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567.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CURVED 5 12.5MM SIGMA XLK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "158115112", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3150.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CURVED 5 15MM SIGMA GVF", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "158115015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2100.0, "discounted_cash": 567.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CURVED 5 15MM SIGMA XLK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "158115115", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3150.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT CURVED 5 17.5MM 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ECCENTRIC 28/50-52 10DEG IMP", "code_information": [{"code": "S-2301-2850", "type": "CDM"}], "standard_charges": [{"gross_charge": 2801.4, "discounted_cash": 756.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ECCENTRIC 28/52 10 DEGERE IMP", "code_information": [{"code": "S-2301-2852", "type": "CDM"}], "standard_charges": [{"gross_charge": 2801.4, "discounted_cash": 756.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ECCENTRIC 28/54-56 10DEG IMP", "code_information": [{"code": "S-2301-2854", "type": "CDM"}], "standard_charges": [{"gross_charge": 2801.4, "discounted_cash": 756.38, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ELECTRD/PM CATH SNGL", "code_information": [{"code": "33210", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, 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TRIATHLON TS PLUS TIBIAL X3 POLY 28MM 5537-G-728-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-728-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9622.8, "discounted_cash": 2598.16, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT NO.1 TRIATHLON TS PLUS TIBIAL X3 POLY 19MM 5537-G-119-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-119-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10103.4, "discounted_cash": 2727.92, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36555", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT NON-TUNNEL CV CATH", "code_information": [{"code": "36556", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": 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charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT OCULAR IMPLANT", "code_information": [{"code": "65135", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ONLAY TIBIAL 180738-2-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "180738-2-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3279.6, "discounted_cash": 885.49, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ONLAY TIBIAL X3 SIZE 3 9MM THICK 180733-2-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "180733-2-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3564.0, "discounted_cash": 962.28, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PACING LEAD & CONNECT", "code_information": [{"code": "33224", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 28862.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 26361.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 8633.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 9837.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 28862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PALATE IMPLANTS", "code_information": [{"code": "C9727", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PATELLA 25MM SIGMA PFC IMP 960120", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "960120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PATELLA 28MM SIGMA PFC IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "960121", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PATELLA 32MM SIGMA PFC IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "960122", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PATELLA LG KINEMATIC", "code_information": [{"code": "6485-5-915", "type": "CDM"}], "standard_charges": [{"gross_charge": 2202.9, "discounted_cash": 594.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PATELLA MED DURATION KINEMATIC", "code_information": [{"code": "6485-3-915", "type": "CDM"}], "standard_charges": [{"gross_charge": 2202.9, "discounted_cash": 594.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PATELLA SCORPIO", "code_information": [{"code": "73-20-5030", "type": "CDM"}], "standard_charges": [{"gross_charge": 1710.0, "discounted_cash": 461.7, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PELV FIXATION DEVICE", "code_information": [{"code": "22848", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PESSARY/OTHER DEVICE", "code_information": [{"code": "57160", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PHALANGEAL 2.5 OFFSET 02", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9P15-PB02-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6123.0, "discounted_cash": 1653.21, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PHALANGEAL 2.5MM OFFSET - 02 (4.6MM THICK)", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "9P15-PB02-W", "type": 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PICVAD CATH", "code_information": [{"code": "36571", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"159913052", "type": "CDM"}], "standard_charges": [{"gross_charge": 2800.2, "discounted_cash": 756.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT POLY 28 X 54 OR 56 DUR OPT", "code_information": [{"code": "159913054", "type": "CDM"}], "standard_charges": [{"gross_charge": 2800.2, "discounted_cash": 756.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT POLY 28 X 54 OR 56 LPW DUR OPT", "code_information": [{"code": "159923054", "type": "CDM"}], "standard_charges": [{"gross_charge": 2669.55, "discounted_cash": 720.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT POLY 28 X 58 OR 60 DUR OPT", "code_information": [{"code": "159913058", "type": "CDM"}], "standard_charges": [{"gross_charge": 2800.2, "discounted_cash": 756.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT POLY 28 X 58 OR 60 LPW DUR OPT", "code_information": [{"code": "159923058", "type": "CDM"}], "standard_charges": [{"gross_charge": 2669.55, "discounted_cash": 720.78, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT POLY 40MM 4 1230-7505-002", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1230-7505-002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2265.0, "discounted_cash": 611.55, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT POLYETHYLENE 36.0MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "623-00-36E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2508.0, "discounted_cash": 677.16, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PRIMARY  13MM  CM  SIZE 4 385-13-504", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "385-13-504", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 18423.0, "discounted_cash": 4974.21, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PROST URETHRAL STENT", "code_information": [{"code": "53855", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT PROSTHESIS 9 X 31MM PATELLA KNEE TRIATHLON X3 POLY", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5550-G-319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1140.0, "discounted_cash": 307.8, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PS SZE 3 THKNS 16MM TRIATHLON X3 TIBIAL BEARING  5532-G-316-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-316-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3990.0, "discounted_cash": 1077.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PS SZE 3 THKNS 93 TRIATHLON X3 TIBIAL BEARING 5532-G-309-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-309-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3990.0, "discounted_cash": 1077.3, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PS SZE 5 THKNS 13MM TIRATHLON X3 TIBIAL BEARING  5532-G-513-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-513-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2280.0, "discounted_cash": 615.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PS SZE 6 THKNS 16MM TRIATHLON X3 TIBIAL BEARING  5532-G-616-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-616-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2280.0, "discounted_cash": 615.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PS SZE 7 THKNS 11MM TRIATHLON X3 TIBIAL BEARING  5532-G-711-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-711-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2280.0, "discounted_cash": 615.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PS SZE 7 THKNS 13MM TRIATHLON X3 TIBIAL BEARING  5532-G-713-E", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5532-G-713-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2280.0, "discounted_cash": 615.6, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT PULSE GEN DUAL LEADS", "code_information": [{"code": "33213", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 28862.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ULTRA TIBIAL 3 X 16 KC-36036 KC-36036", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "KC-36036", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT ULTRA TIBIAL CS 4 X 14MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "KC-36044", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4123.68, "discounted_cash": 1113.39, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT URETERAL SUPPORT", "code_information": [{"code": "50605", "type": "CPT"}], "standard_charges": 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT VITALITE 36MM ID 56MM 1724-0-3656", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1724-0-3656", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 648.0, "setting": "both", "billing_class": "facility"}]}, {"description": "INSERT 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970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 9337.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36800", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CANNULA", "code_information": [{"code": "36815", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CATHETER VEIN", "code_information": [{"code": "36500", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, 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1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF CHEST TUBE", "code_information": [{"code": "32551", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF INFUSION PUMP", "code_information": [{"code": "36260", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 1980.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6621.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERTION OF SPINAL NEUROSTIMULATOR 63685", 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"AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH SEC IO LENS", "code_information": [{"code": "618T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 10394.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 10394.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ IRIS PROSTH W/RMVL&INSJ", "code_information": [{"code": "617T", "type": "CPT"}], 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ OCULAR TELESCOPE PROSTH", "code_information": [{"code": "308T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 22671.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD L HRT ARTL&VEN", "code_information": [{"code": "33991", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PERQ VAD R HRT VENOUS", "code_information": [{"code": "33995", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM SYS", "code_information": [{"code": "33276", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 33820.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PHRNC NRV STIM TRANSVNS", "code_information": [{"code": "33277", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC <5 YR W/O IMAGING", "code_information": [{"code": "36568", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ PICC RS&I <5 YR", "code_information": [{"code": "36572", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ RX ELUT IMPLT LAC CANAL", "code_information": [{"code": "68841", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ CAR RHYTHM MNTR", "code_information": [{"code": "33285", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ SUBQ IMPLTBL DFB ELCTRD", "code_information": [{"code": "33271", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 48724.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 48724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV BOTH COMPNT PG", "code_information": [{"code": "517T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV COMPL SYS", "code_information": [{"code": "515T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 33820.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ WCS LV ELTRD ONLY", "code_information": [{"code": "516T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ ATR ELT", "code_information": [{"code": "410T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLC CAR MODULJ PLS GN", "code_information": [{"code": "409T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 33820.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT COMPL IIMS", "code_information": [{"code": "525T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 9621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 44504.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 48724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT ICDS SS ELTRD", "code_information": [{"code": "571T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 33820.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS ELTRD ONLY", "code_information": [{"code": "526T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT IIMS IMPLT MNTR", "code_information": [{"code": "527T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSJ/RPLCMT PG ONLY ISDSS", "code_information": [{"code": "680T", "type": "CPT"}], 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 8633.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 28862.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 9837.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/DUAL LEADS", "code_information": [{"code": "33230", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 48724.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 48724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/MULT LEADS", "code_information": [{"code": "33231", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 48724.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 48724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT PULSE GEN W/SINGL LEAD", "code_information": [{"code": "33240", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 48724.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 44504.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 48724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSRT/REDO NEUROSTIM 1 ARRAY", "code_information": [{"code": "61885", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 22671.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTLL RX AGNT INTO RNAL TUB", "code_information": [{"code": "50391", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSTR BIOPSY MAXCORE PINK SWTCH 18GX MC1820", "code_information": [{"code": "MC1820", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 159.67, "discounted_cash": 43.11, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTR BIOPSY MAXCORE PINK SWTCH 18GX25CM", "code_information": [{"code": "MC1825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 158.08, "discounted_cash": 42.68, 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"discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BROACH 11MM EXACT ALLIANCE", "code_information": [{"code": "X31-400011", "type": "CDM"}], "standard_charges": [{"gross_charge": 2175.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BROACH 12MM EXACT ALLIANCE", "code_information": [{"code": "X31-400012", "type": "CDM"}], "standard_charges": [{"gross_charge": 2175.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BROACH 14MM EXACT ALLIANCE", "code_information": [{"code": "X31-400014", "type": "CDM"}], "standard_charges": [{"gross_charge": 2175.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BROACH 15MM PROVISIONAL EXACT ALLIANCE", "code_information": [{"code": "X31-400015", "type": "CDM"}], "standard_charges": [{"gross_charge": 2175.0, "discounted_cash": 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"discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BROACH 20MM PROVISIONAL EXACT ALLIANCE", "code_information": [{"code": "X31-400020", "type": "CDM"}], "standard_charges": [{"gross_charge": 2175.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BROACH 21MM PROVISIONAL EXACT ALLIANCE", "code_information": [{"code": "X31-400021", "type": "CDM"}], "standard_charges": [{"gross_charge": 2175.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BROACH 7MM PROVISIONAL EXACT ALLIANCE", "code_information": [{"code": "X31-400007", "type": "CDM"}], "standard_charges": [{"gross_charge": 2175.0, "discounted_cash": 587.25, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT BROACH 8MM PROVISIONAL EXACT ALLIANCE", "code_information": [{"code": "X31-400008", "type": "CDM"}], "standard_charges": 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196.91, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SURG 9MM DUAL RETROCUTTER", "code_information": [{"code": "AR-1204RD-09S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 663.0, "discounted_cash": 179.01, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT SURGICAL HARVESTER BONE GRAFT 10MM P99-931-0010-SK", "code_information": [{"code": "P99-931-0010-SK", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4208.75, "discounted_cash": 1136.36, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENT TAP 3.5MM QUICK CONNECT", "code_information": [{"code": "DRUJ-T35", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 507.38, "discounted_cash": 136.99, "setting": "both", "billing_class": "facility"}]}, {"description": "INSTRUMENTATION SINGLE USE STERILE", "code_information": [{"code": "MTK-10", 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[{"gross_charge": 22.5, "discounted_cash": 6.08, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERSTIM RECHARGER KIT RS5200", "code_information": [{"code": "RS5200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4387.5, "discounted_cash": 1184.63, "setting": "both", "billing_class": "facility"}]}, {"description": "INTERTHORACOSCPLR AMPUTATION", "code_information": [{"code": "23900", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR FACE/MM 7.6-12.5CM", "code_information": [{"code": "12054", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTMD RPR N-HF/GENIT7.6-12.5", "code_information": [{"code": "12044", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61682", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRACRANIAL VESSEL SURGERY", "code_information": [{"code": "61686", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRANASAL RECONSTRUCTION", "code_information": [{"code": "30620", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP COLON LAVAGE ADD-ON", "code_information": [{"code": "44701", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP HIPEC PX 1ST 60 MIN", "code_information": [{"code": "96547", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BREAST 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAOP OCT BRST/NODE SPEC", "code_information": [{"code": "351T", "type": "CPT"}], "standard_charges": [{"minimum": 1.06, "maximum": 1810.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAVENOUS INFUSION FOR THERAPY PROPHYLAXIS OR DIAGNOSIS INITIAL UP TO 1 HOUR 96365", "code_information": [{"code": "96365", "type": "CPT"}, {"code": "2401822", "type": "CDM"}, {"code": "260", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 724.0, "discounted_cash": 195.48, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAVENTRICULAR PACING", "code_information": [{"code": "93612", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8242.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8242.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRAVERTEBRAL FX AUG IMPL", "code_information": [{"code": "C1062", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "INTRINSIC FACTOR ANTIBODY", "code_information": [{"code": "86340", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 13.57, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36902", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRO CATH DIALYSIS CIRCUIT", "code_information": [{"code": "36903", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTRODUCER ABDOMINAL 21MM TRANS ANAL DISP", "code_information": [{"code": "EEATAID21D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.35, "discounted_cash": 64.62, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER ASSEBMLY TEARAWAY 23003-045", "code_information": [{"code": "C1883", "type": "HCPCS"}, {"code": 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2596.26, "discounted_cash": 700.99, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER OSTEOSITE VERTEBRAL AUGMENTATION 11G 12CM VA1112", "code_information": [{"code": "VA1112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 73.44, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER OSTO-SITE VERTEBRAL AUG 10G 12CM VA1012", "code_information": [{"code": "VA1012", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 374.0, "discounted_cash": 100.98, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER SURG 10MM 2MM 1ST FIX TRAY KPHPK XPR", "code_information": [{"code": "KPE1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14033.5, "discounted_cash": 3789.05, "setting": "both", "billing_class": "facility"}]}, {"description": "INTRODUCER TRANS ANAL/ABDOMINAL 25MM 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"plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE 31500", "code_information": [{"code": "31500", "type": "CPT"}, {"code": "15213991", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 668.0, "discounted_cash": 180.36, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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"Influenza virus vaccine, quadrivalent, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 40 mcg/0.4 mL dosage, for intramuscular use", "code_information": [{"code": "90613", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Influenza virus vaccine, trivalent, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 31.7 mcg/0.32 mL dosage, for intramuscular use", "code_information": [{"code": "90612", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": 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"standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Injection, ustekinumab-aauz (Otulfi), biosimilar, 1 mg", "code_information": [{"code": "Q9999", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Inpatient Hospital Consultation, Typically 20 Minutes", "code_information": [{"code": "99251", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": 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"payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 15.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "JOINT PROSTHESIS PIP SILICONE SZ 1", "code_information": [{"code": "L8658", "type": "HCPCS"}, {"code": "SPIP-520-1-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5550.0, "discounted_cash": 1498.5, "setting": "both", "billing_class": "facility"}]}, {"description": "JOYSTICK FOR T10 SCREW HOLES", "code_information": [{"code": "703928", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1649.38, "discounted_cash": 445.33, "setting": "both", "billing_class": "facility"}]}, {"description": "JRF GRAFTLINK 10.0 X 70MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "151814-017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6975.0, "discounted_cash": 1883.25, "setting": "both", "billing_class": "facility"}]}, {"description": "JRF GRAFTLINK 10.0 X 72MM", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "152620-015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6900.0, "discounted_cash": 1863.0, "setting": "both", "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE MULTIPLE", "code_information": [{"code": "78709", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 412.72, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/DRUG", "code_information": [{"code": "78708", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 179.22, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K FLOW/FUNCT IMAGE W/O DRUG", "code_information": [{"code": "78707", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 270.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "K WIRE .054 WS-1406 ST", "code_information": [{"code": "WS-1406 ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 11.34, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 0.035 1600-1635", "code_information": [{"code": "1600-1635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.6, "discounted_cash": 3.94, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 0.045", "code_information": [{"code": "1600-1645", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 14.6, "discounted_cash": 3.94, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 0.062", "code_information": [{"code": "1600-1662", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.88, "discounted_cash": 3.75, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE 0.9 K09100", "code_information": [{"code": "K09100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 294.94, "discounted_cash": 79.63, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE DRILL TIP 2.0 X 234 MM", "code_information": [{"code": "705002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 146.11, "discounted_cash": 39.45, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE EQUINOXE PHX TROCAR 200MM 371-20-00", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "371-20-00", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 405.0, "discounted_cash": 109.35, "setting": "both", "billing_class": "facility"}]}, {"description": "K WIRE NITINOL 500MM", "code_information": [{"code": "S100241", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 91.8, "setting": "both", "billing_class": "facility"}]}, {"description": "K- WIRE WIRE-1.6/150", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6/150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 16.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  0.9MM X 152MM  DOUBLE TROCAR KWIR-HCS-09152", "code_information": [{"code": "KWIR-HCS-09152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 19.44, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  1.5MM X 127MM KWIR-DES-15127", "code_information": [{"code": "KWIR-DES-15127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.25, "discounted_cash": 23.29, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  1.5MM X 127MM KWIR-STD-15127", "code_information": [{"code": 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"setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE  STANDARD TIP  2.0 MM X 152 MM KWIR-STD-20152", "code_information": [{"code": "KWIR-STD-20152", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 104.88, "discounted_cash": 28.32, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .035IN X 6.0IN", "code_information": [{"code": "WS-0906ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 17.01, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .045X6IN MSG16001645", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MSG16001645", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11.85, "discounted_cash": 3.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE .062 144256", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": 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{"description": "K-WIRE 0.8 X 120", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-0.8/120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 42.0, "discounted_cash": 11.34, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.8MM x 150MM THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30.208.150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 20.25, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9 X 127MM DOUBLE TROCAR KWIR-DT-09127", "code_information": [{"code": "KWIR-DT-09127", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 19.44, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 0.9 X 150MM SMOOTH", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P99-192-0915", 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{"description": "K-WIRE 0.9MM X 35", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "320-5009", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 26.25, "discounted_cash": 7.09, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.0 LG150 TR/RD COCR CKW02004", "code_information": [{"code": "CKW02004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.5, "discounted_cash": 27.95, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.0 LG150 TR/RD COCR CKW02005", "code_information": [{"code": "CKW02005", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 103.5, "discounted_cash": 27.95, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1/100 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.1/100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 16.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1/120 MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.1/120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 16.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1MM  102MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "62001002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 19.44, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.1MM x 150MM THREADED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "30.211.150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 75.0, "discounted_cash": 20.25, "setting": "both", "billing_class": "facility"}]}, 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[{"gross_charge": 326.4, "discounted_cash": 88.13, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.4MM   K100-14S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "K100-14S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 535.5, "discounted_cash": 144.59, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.4MM X 203MM SINGLE TROCAR KWIR-ST-14203", "code_information": [{"code": "KWIR-ST-14203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 120.75, "discounted_cash": 32.6, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6/065", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "WIRE-1.6/065", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60.0, "discounted_cash": 16.2, "setting": "both", "billing_class": "facility"}]}, {"description": "K-WIRE 1.6/100", 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "KIDNEY ENDOSCOPY & TREATMENT", "code_information": [{"code": "50561", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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{"description": "KIT ASEPTIC 48IN TUBING X 10IN ASEPTIC TRANSFER SYS KIT CHEST BREAST TRAY LF", "code_information": [{"code": "350-8400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 50.63, "discounted_cash": 13.67, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BALLOON OMNICURVE FRACTURE 11G X 20MM 1032-120-000", "code_information": [{"code": "1032-120-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8377.14, "discounted_cash": 2261.83, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BEAD 25CC RESORBABLE MINI OSTEOSET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8400-0311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3087.0, "discounted_cash": 833.49, "setting": "both", "billing_class": "facility"}]}, {"description": "KIT BEARING EXTRA SM ULNA REV DISCOVERY", "code_information": [{"code": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "L HRT ART/GRFT ANGIO", "code_information": [{"code": "93459", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ESOPH LENGTHENING", "code_information": [{"code": "43283", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ESOPHAGOMYOTOMY", "code_information": [{"code": "S2079", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP GASTR BYPASS INCL SMLL I", "code_information": [{"code": "43645", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP ILEO/JEJUNO-STOMY", "code_information": [{"code": "44187", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP IMPL ELECTRODE ANTRUM", "code_information": [{"code": "43647", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP INS DEVICE FOR RT", "code_information": [{"code": "49327", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REMOVE RECTUM W/POUCH", "code_information": [{"code": "45397", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 15611.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP RESECT S/INTESTINE ADDL", "code_information": [{"code": "44203", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 15611.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISE/REMV ELTRD ANTRUM", 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP REVISION PERM IP CATH", "code_information": [{"code": "49325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAP.VAGINAL HYST.UTERUS 250 G OR LESS W/REMOVAL OF TUBES/OVARY 58552", "code_information": [{"code": 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL COLECTOMY", "code_information": [{"code": "44204", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO PARTIAL NEPHRECTOMY", "code_information": [{"code": "50543", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO RADICAL NEPHRECTOMY", "code_information": [{"code": "50545", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"description": "LAPARO REMOVAL DONOR KIDNEY", "code_information": [{"code": "50547", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPARO REMOVE W/URETER", "code_information": [{"code": "50548", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPAROSCOPIC TREATMENT OF ECTOPIC PREG. 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LAPIDUS NAIL GUIDE PIN AND DRILL 2.75MM X 200MM MEASURING LASER MARKED", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P30-196-2720", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 575.25, "discounted_cash": 155.32, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPIDUS PLATE LC ALPHA 18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7100-LC18-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5271.75, "discounted_cash": 1423.37, "setting": "both", "billing_class": "facility"}]}, {"description": "LAPIDUS PLATE LC 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5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS INSJ 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS PELVIC LYMPHADEC", "code_information": [{"code": "38573", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS 1ST LD", "code_information": [{"code": "677T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 4876.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LAPS REPOS LEAD ISDSS EA ADD", "code_information": [{"code": "678T", "type": "CPT"}], "standard_charges": 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARGSC W/THER INJECTION", "code_information": [{"code": "31573", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYGOSCOPE GVL S3", "code_information": [{"code": "574-0100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 70.56, "discounted_cash": 19.05, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYGOSCOPE GVL S4", "code_information": [{"code": "270-0628", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 82.58, "discounted_cash": 22.3, "setting": "both", "billing_class": "facility"}]}, {"description": "LARYNGEAL FUNCTION STUDIES", "code_information": [{"code": "92520", "type": "CPT"}], 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL STEN", "code_information": [{"code": "31552", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOPLASTY LARYNGEAL WEB", "code_information": [{"code": "31580", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOP W/VC INJ + SCOPE", "code_information": [{"code": "31571", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPIC SENSORY I&R", "code_information": [{"code": "92615", "type": "CPT"}], "standard_charges": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY AND DILATION", "code_information": [{"code": "31529", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY TELESCOPIC", "code_information": [{"code": "31579", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BIOPSY", "code_information": [{"code": "31535", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/BX & OP SCOPE", "code_information": 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charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/EXC OF TUMOR", "code_information": [{"code": "31540", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB & OP 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNGOSCOPY W/FB REMOVAL", "code_information": [{"code": "31530", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LARYNSCOP REMVE CART + SCOP", "code_information": [{"code": "31561", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER IN SITU KERATOMILEUSIS", "code_information": [{"code": "S0800", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER LINER 28MM 10DEG S ROM", "code_information": [{"code": "873554", "type": "CDM"}], "standard_charges": [{"gross_charge": 7131.15, "discounted_cash": 1925.41, "setting": "both", "billing_class": "facility"}]}, {"description": "LASER SURG PENIS LESION(S)", "code_information": [{"code": "54057", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"billing_class": "facility"}]}, {"description": "LASER SURGERY EYE STRANDS", "code_information": [{"code": "67031", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF CERVIX", "code_information": [{"code": "57513", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52647", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LASER SURGERY OF PROSTATE", "code_information": [{"code": "52648", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LENGTHENING OF THIGH BONE", "code_information": [{"code": "27466", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"LF1637", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1540.6, "discounted_cash": 415.96, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE BLUNT TIP LAPAROSCOPIC 20 X 5MM", "code_information": [{"code": "LF1644", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1628.29, "discounted_cash": 439.64, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE LAPROSCOPIC 23CM MARYLAND JAW OPEN DEVICE", "code_information": [{"code": "LF1723", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1591.65, "discounted_cash": 429.75, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGASURE MARYLAND JAW 5MM-37 CM", "code_information": [{"code": "LF1737", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1575.57, "discounted_cash": 425.4, "setting": "both", "billing_class": "facility"}]}, {"description": "LIGATE ESOPHAGUS VEINS", "code_information": [{"code": "43400", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE LEG VEINS RADICAL", "code_information": [{"code": "37760", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE OVIDUCT(S) ADD-ON", "code_information": [{"code": "58611", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STAPLE ESOPHAGUS", "code_information": [{"code": "43405", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATE/STRIP LONG LEG VEIN", "code_information": [{"code": "37722", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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[{"minimum": 0.5, "maximum": 5946.0, "gross_charge": 6923.0, "discounted_cash": 1869.21, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 5192.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF A-V FISTULA", "code_information": [{"code": "37607", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF ABDOMEN ARTERY", "code_information": [{"code": "37617", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF CHEST ARTERY", "code_information": [{"code": "37616", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF EXTREMITY ARTERY", "code_information": [{"code": "37618", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF INF VENA CAVA", "code_information": [{"code": "37619", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIGATION OF NECK ARTERY", "code_information": [{"code": "37600", "type": "CPT"}], "standard_charges": 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"HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 2586.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIQUID ADHSV 2 ML X 3 ML SURG BANDAGE ADHSV TIP VIAL MASTISTOL LF STRL", "code_information": [{"code": "523-48", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.69, "discounted_cash": 2.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LIQUID MASTISOL 052348", "code_information": [{"code": "52348", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.69, "discounted_cash": 2.35, "setting": "both", "billing_class": "facility"}]}, {"description": "LISTERIA MONOCYTOGENES", "code_information": [{"code": "86723", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 11.87, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LITT ICR 1 TRAJ 1 SMPL LES", "code_information": [{"code": "61736", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER & SPLEEN IMAGE/FLOW", "code_information": [{"code": "78216", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 151.41, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVER AND SPLEEN IMAGING", "code_information": [{"code": "78215", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 233.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 252.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIVERPOOL CUTTING JIG PIN", "code_information": [{"code": "408033", "type": "CDM"}], "standard_charges": [{"gross_charge": 348.0, "discounted_cash": 93.96, "setting": "both", "billing_class": "facility"}]}, {"description": "LIVERPOOL INSTRUMENT CASE", "code_information": [{"code": "408037", "type": "CDM"}], "standard_charges": [{"gross_charge": 5784.0, "discounted_cash": 1561.68, "setting": "both", "billing_class": "facility"}]}, {"description": "LIVERPOOL RADIAL HD IMPACTOR", "code_information": [{"code": "408032", "type": "CDM"}], "standard_charges": [{"gross_charge": 792.0, "discounted_cash": 213.84, "setting": "both", "billing_class": "facility"}]}, {"description": "LIVERPOOL RADIAL HEAD CUTTING JIG", "code_information": [{"code": "408030", "type": "CDM"}], "standard_charges": [{"gross_charge": 1188.0, "discounted_cash": 320.76, "setting": "both", "billing_class": "facility"}]}, {"description": "LIVERPOOL RADIAL HEAD INSERT/ALIGN", "code_information": [{"code": "408031", "type": "CDM"}], "standard_charges": [{"gross_charge": 4824.0, "discounted_cash": 1302.48, "setting": "both", "billing_class": "facility"}]}, {"description": "LIVERPOOL RADIAL HOOK", "code_information": [{"code": "408034", "type": "CDM"}], "standard_charges": [{"gross_charge": 1941.0, "discounted_cash": 524.07, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA DISPOSABLE SZ 3", "code_information": [{"code": "321 300 000U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.4, "discounted_cash": 11.99, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA SZ 3 105200-000030", "code_information": [{"code": "105200-000030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.75, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA SZ 4 105200-000040", "code_information": [{"code": "105200-000040", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.75, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "LMA UNIQUE SILICONE CUFF AIRWAY SIZE 5 105200-000050", "code_information": [{"code": "105200-000050", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.75, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "LMTD OPH EXAM GENERAL ANES", "code_information": [{"code": "92019", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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"discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "LNR PUSHER HD 22MM", "code_information": [{"code": "423613", "type": "CDM"}], "standard_charges": [{"gross_charge": 612.0, "discounted_cash": 165.24, "setting": "both", "billing_class": "facility"}]}, {"description": "LNR PUSHER HD 26MM", "code_information": [{"code": "423616", "type": "CDM"}], "standard_charges": [{"gross_charge": 612.0, "discounted_cash": 165.24, "setting": "both", "billing_class": "facility"}]}, {"description": "LNR PUSHER HD 28MM", "code_information": [{"code": "423614", "type": "CDM"}], "standard_charges": [{"gross_charge": 612.0, "discounted_cash": 165.24, "setting": "both", "billing_class": "facility"}]}, {"description": "LNR PUSHER HD 32MM", "code_information": [{"code": "423615", "type": "CDM"}], "standard_charges": [{"gross_charge": 612.0, "discounted_cash": 165.24, "setting": "both", "billing_class": "facility"}]}, {"description": "LNT IMPLANT SYSTEM 2.9 BC PUSHLOCK 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"discounted_cash": 46.77, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP VESSEL DEV-O-LOOP RED MAXI", "code_information": [{"code": "31145744", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.99, "discounted_cash": 2.7, "setting": "both", "billing_class": "facility"}]}, {"description": "LOOP VESSEL MINI RED STERION STRL", "code_information": [{"code": "11001PBX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.69, "discounted_cash": 3.16, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOSIS 22MM WIDTH  50MM LENGTH  12MM HEIGHT  8DEG  8604-5012", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "8604-5012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 15000.0, "discounted_cash": 4050.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC CAGE ROI-C  CERVICAL   12X15.5 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MC1458P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6600.0, "discounted_cash": 1782.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LORDOTIC IMPLANT ROI-C", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "MC1423P", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "LOTION REMEDY ESSENTIALS BODY UNSCENTED 2 OZ MSC092MBL02", "code_information": [{"code": "MSC092MBL02", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "LOUDNESS BALANCE TEST", "code_information": [{"code": "92562", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW DENSITY LIPOPROTEIN(LDL)", "code_information": [{"code": "S2120", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW FREQUENCY NON-THERMAL US", "code_information": [{"code": "97610", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOW NTSTY ESWT CORPUS CVRNSM", "code_information": [{"code": "864T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "LOW PROFILE HEAD RMVL FORK", "code_information": [{"code": "407389", "type": "CDM"}], "standard_charges": [{"gross_charge": 1137.0, "discounted_cash": 306.99, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE SHL IMPACTOR PLT SZ 42", "code_information": [{"code": "423672", "type": "CDM"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 210.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE SHL IMPACTOR PLT SZ 43", "code_information": [{"code": "423673", "type": "CDM"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 210.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE SHL IMPACTOR PLT SZ 44", "code_information": [{"code": "423674", "type": "CDM"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 210.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE SHL IMPACTOR PLT SZ 45", "code_information": [{"code": "423675", "type": "CDM"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 210.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE SHL IMPACTOR PLT SZ 46", "code_information": [{"code": "423676", "type": "CDM"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 210.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE SHL IMPACTOR PLT SZ 47", "code_information": [{"code": "423677", "type": "CDM"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 210.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW PROFILE SHL IMPACTOR PLT SZ 48", "code_information": [{"code": "423678", "type": "CDM"}], "standard_charges": [{"gross_charge": 780.0, "discounted_cash": 210.6, "setting": "both", "billing_class": "facility"}]}, {"description": "LOW-LEVEL LASER THERAPY", "code_information": [{"code": "552T", "type": "CPT"}], "standard_charges": [{"minimum": 3419.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LOWER EXTREMITY FLAP 15738", "code_information": [{"code": "15738", "type": "CPT"}, {"code": "1481272", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6845.25, "gross_charge": 9127.0, "discounted_cash": 2464.29, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LP SCREW 3.0X14MM CORTICAL MTP TI AR-9933-14", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9933-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 406.5, "discounted_cash": 109.76, "setting": "both", "billing_class": "facility"}]}, {"description": "LP SCREW 3.0X24MM CORTICAL MTP TI AR-9933-24", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9933-24", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 406.5, "discounted_cash": 109.76, "setting": "both", "billing_class": "facility"}]}, {"description": "LR 3000ML BAG", "code_information": [{"code": "MED0270", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 49.02, "discounted_cash": 13.24, "setting": "both", "billing_class": "facility"}]}, {"description": "LRNSCP FLX 3.8IN ASCOPE 3 INTBT HNDL LUER CONN LEN DSGN BEND", "code_information": [{"code": "402001000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 894.1, "discounted_cash": 241.41, "setting": "both", "billing_class": "facility"}]}, {"description": "LSH UTERUS 250 G OR LESS", "code_information": [{"code": "58541", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH UTERUS ABOVE 250 G", "code_information": [{"code": "58543", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UT 250 G OR LESS", "code_information": [{"code": "58542", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LSH W/T/O UTERUS ABOVE 250 G", "code_information": [{"code": "58544", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUBRICANT ENDOGLIDE+ 2.0OZ 50/BOX M00501902", "code_information": [{"code": "M00501902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.44, "discounted_cash": 2.55, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICANT OIL DIFFUSER MIDAS REX LEGEND", "code_information": [{"code": "PA-100A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 68.99, "discounted_cash": 18.63, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICATING JELLY 120GM TUBE", "code_information": [{"code": "MED0133", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.98, "discounted_cash": 5.66, "setting": "both", "billing_class": "facility"}]}, {"description": "LUBRICATING JELLY IN FOIL PACK 2.7 G MDS032273H", "code_information": [{"code": "MDS032273H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "LUG FEMORAL PRIMARY GII", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "71420999", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 138.6, "discounted_cash": 37.42, "setting": "both", "billing_class": "facility"}]}, {"description": "LUGOLS 30ML SOLUTION", "code_information": [{"code": "MED0134", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 173.05, "discounted_cash": 46.72, "setting": "both", "billing_class": "facility"}]}, {"description": "LUNATE SZ 3", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "LUN-710-03-WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13739.4, "discounted_cash": 3709.64, "setting": "both", "billing_class": "facility"}]}, {"description": "LUNG BX PLUG W/DEL SYS", "code_information": [{"code": "C2613", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG FUNCTION TEST (MBC/MVV)", "code_information": [{"code": "94200", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERF&VENTILAT DIFERENTL", "code_information": [{"code": "78598", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG PERFUSION DIFFERENTIAL", "code_information": [{"code": "78597", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT DOUBLE", "code_information": [{"code": "32853", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32852", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG TRANSPLANT WITH BYPASS", "code_information": [{"code": "32854", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILAT&PERFUS IMAGING", "code_information": [{"code": "78582", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VENTILATION IMAGING", "code_information": [{"code": "78579", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUNG VOLUME REDUCTION", "code_information": [{"code": "32491", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LUPINE BR ANCHOR W/ORTHOCORD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "210711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1569.0, "discounted_cash": 423.63, "setting": "both", "billing_class": "facility"}]}, {"description": "LYME DIS DNA AMP PROBE", "code_information": [{"code": "87476", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 31.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DIS DNA DIR PROBE", "code_information": [{"code": "87475", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE ANTIBODY", "code_information": [{"code": "86617", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 13.94, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYME DISEASE ANTIBODY", "code_information": [{"code": "86618", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 15.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH CHORIOMENINGITIS AB", "code_information": [{"code": "86727", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 11.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH SYSTEM IMAGING", "code_information": [{"code": "78195", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 389.36, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 534.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARM/LEG", "code_information": [{"code": "75801", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 68.59, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 613.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY ARMS/LEGS", "code_information": [{"code": "75803", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 96.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LYMPH VESSEL X-RAY TRUNK", "code_information": [{"code": "75805", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 67.25, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"gross_charge": 4785.0, "discounted_cash": 1291.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"type": "CDM"}], "standard_charges": [{"gross_charge": 882.0, "discounted_cash": 238.14, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO RADIAL STEM PROV 6.0X40MM", "code_information": [{"code": "409181", "type": "CDM"}], "standard_charges": [{"gross_charge": 882.0, "discounted_cash": 238.14, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO RADIAL STEM PROV 7.5X40MM", "code_information": [{"code": "409182", "type": "CDM"}], "standard_charges": [{"gross_charge": 882.0, "discounted_cash": 238.14, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO RADIAL STEM PROV 9.0X40MM", "code_information": [{"code": "409183", "type": "CDM"}], "standard_charges": [{"gross_charge": 882.0, "discounted_cash": 238.14, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO RADIAL W/BRG 7X15MM 7.5 LT", "code_information": [{"code": "180150", "type": "CDM"}], "standard_charges": [{"gross_charge": 8520.0, "discounted_cash": 2300.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO RADIAL W/BRG 7X15MM 7.5 RT", "code_information": [{"code": "180151", "type": "CDM"}], "standard_charges": [{"gross_charge": 8520.0, "discounted_cash": 2300.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO RADIAL W/BRG 7X15MM 9.0 LT", "code_information": [{"code": "180152", "type": "CDM"}], "standard_charges": [{"gross_charge": 8520.0, "discounted_cash": 2300.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO RADIAL W/BRG 7X15MM 9.0 RT", "code_information": [{"code": "180153", "type": "CDM"}], "standard_charges": [{"gross_charge": 8520.0, "discounted_cash": 2300.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO SCREW DEPTH GUIDE", "code_information": [{"code": "409085", "type": "CDM"}], "standard_charges": [{"gross_charge": 4098.0, "discounted_cash": 1106.46, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO SCREW HEX DRIVER", "code_information": [{"code": "409082", "type": "CDM"}], "standard_charges": [{"gross_charge": 1221.0, "discounted_cash": 329.67, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TAPERED HEAD EXTRACTOR", "code_information": [{"code": "409469", "type": "CDM"}], "standard_charges": [{"gross_charge": 4809.0, "discounted_cash": 1298.43, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CAPITATE STEM 6X12MM", "code_information": [{"code": "180320", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CAPITATE STEM 6X15MM", "code_information": [{"code": "180321", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CAPITATE STEM 6X18MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL HD 7X15MM +2", "code_information": [{"code": "180364", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL HD 7X15MM +4", "code_information": [{"code": "180365", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL HD 7X15MM STD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180363", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X37 12 AUG", "code_information": [{"code": "180305", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X37 6 AUG", "code_information": [{"code": "180303", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X37 9 AUG", "code_information": [{"code": "180304", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X37MM", "code_information": [{"code": "180395", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X43 11 AUG", "code_information": [{"code": "180307", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X43 14 AUG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "180308", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X43 8 AUG", "code_information": [{"code": "180306", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TC CARPAL PLT 9X43MM", "code_information": [{"code": "180396", "type": "CDM"}], "standard_charges": [{"gross_charge": 6651.0, "discounted_cash": 1795.77, "setting": "both", "billing_class": "facility"}]}, {"description": "MAESTRO TPRD CRPL PLT IMPACTOR", "code_information": [{"code": "409466", "type": "CDM"}], "standard_charges": [{"gross_charge": 855.0, "discounted_cash": 230.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MAG CTRLD CAPSULE ENDOSCOPY", "code_information": [{"code": "651T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAGNETIC IMAGE BONE MARROW", "code_information": [{"code": "77084", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 526.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"code_information": [{"code": "33750", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33755", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33762", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAJOR VESSEL SHUNT", "code_information": [{"code": "33766", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 2 - 8 MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "180732-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3394.8, "discounted_cash": 916.6, "setting": "both", "billing_class": "facility"}]}, {"description": "MAKO X3 UNI ONLAY TIBIAL INSERT SIZE 8 8 MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "180738-1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3279.6, "discounted_cash": 885.49, "setting": "both", "billing_class": "facility"}]}, {"description": "MALARIA ANTIBODY", "code_information": [{"code": "86750", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 4450.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANIPULATION FINGER JOINT 26340", "code_information": [{"code": "26340", "type": "CPT"}, {"code": "1481280", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1234.0, "discounted_cash": 333.18, "setting": "both", 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 327.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL PREP AND INSERTION DRUG DELIVERY DEVICE INTRA-ARTICULAR  20704", "code_information": [{"code": "20704", "type": "CPT"}, {"code": "45581521", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 535.0, "discounted_cash": 144.45, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 401.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL PREP AND INSERTION DRUG DELIVERY DEVICE INTRAMEDULLARY  20702", "code_information": [{"code": "20702", "type": "CPT"}, {"code": "45581519", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 458.0, "discounted_cash": 123.66, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 343.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MANUAL RETICULOCYTE COUNT", "code_information": [{"code": "85044", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAP TACHYCARDIA ADD-ON", "code_information": [{"code": "93609", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8242.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARCAINE 0.75% SPINAL 2ML", "code_information": [{"code": "MED0139", "type": "CDM"}], "standard_charges": [{"gross_charge": 11.04, "discounted_cash": 2.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER FEDUCIAL .75MM X .5 CM PRELOADED COIL", "code_information": [{"code": "VC-075-005-PL", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.0, "discounted_cash": 125.55, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN DUAL TIPINK TIME OUT SLEEVE AND RULER FOURIN ONE PEN W/ TIME OUT SLE", "code_information": [{"code": "1041-NNS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.9, "discounted_cash": 2.13, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN GENTIAN VIOLETINK SURG REG TIP W/ 6IN RULER AND 6 BLANK LABEL LF STR", "code_information": [{"code": "DYNJSM02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SKIN REGTIP BARRL W RULER&LBL 250GPRL", "code_information": [{"code": "250GPRL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SPOT 5CC ENDOSCOPY", "code_information": [{"code": "GIS-44", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 569.25, "discounted_cash": 153.7, "setting": "both", "billing_class": "facility"}]}, {"description": "MARKER SURG GENTIAN VIOLET SKIN STANDARD TIP W/ FLEXIBLE RULER DEVON STRL", "code_information": [{"code": "31145785", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION ODON CYST", "code_information": [{"code": "D7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST 56440", "code_information": [{"code": "56440", "type": "CPT"}, {"code": "1481284", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 585.0, "discounted_cash": 157.95, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 438.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASK  LARYNGEAL SUP AIRWAY STERILE SZ 3 ALBF030SU", "code_information": [{"code": "ALBF030SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.72, "discounted_cash": 12.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK  LARYNGEAL SUP AIRWAY STERILE SZ 4 ALBF040SU", "code_information": [{"code": "ALBF040SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.72, "discounted_cash": 12.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK  SURGICAL FOG FREE FOAM", "code_information": [{"code": "AT71235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ADULT 8 FT TUBING W/UNIV CONNECTOR", "code_information": [{"code": "3102-E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.55, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AEROSOL UNDER CHIN 001206", "code_information": [{"code": "1206", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANES 4 SM SWTDRM AR CSH ADJ INFL VLV TRDRP SHP SCNT", "code_information": [{"code": "1242", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.36, "discounted_cash": 2.53, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANES BUBBLE GUM SCENTED CUSHION CASE OF 50 MASKS SWEET DREAMS PEDI", "code_information": [{"code": "1145", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.83, "discounted_cash": 1.84, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA SZ 4 BUBBLE GUM SCENTED CUSHION SWEET DREAMS PEDI", "code_information": [{"code": "1142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.21, "discounted_cash": 2.49, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ANESTHESIA SZ 6 LG NASAL ORAL WITHOUT STRP ADLT DISP", "code_information": [{"code": "1065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.44, "discounted_cash": 1.74, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AURA SURG PARTICULATERESPIRATOR 1870+", "code_information": [{"code": "1870+", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.26, "discounted_cash": 3.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AURAGAIN SZ 4 ACCESS TUBING", "code_information": [{"code": "408400000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.73, "discounted_cash": 21.53, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AURAGAIN SZ 5 ACCESS TUBING", "code_information": [{"code": "408500000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.92, "discounted_cash": 21.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AURASTRAIGHT LARYNGEAL SIZE 3 324300000U", "code_information": [{"code": "324300000U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.8, "discounted_cash": 9.67, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AURASTRAIGHT LARYNGEAL SIZE 4 1", "code_information": [{"code": "324400000U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 39.86, "discounted_cash": 10.76, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK AURASTRAIGHT LARYNGEAL SIZE 5 10 CS", "code_information": [{"code": "324500000U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.54, "discounted_cash": 16.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BASIC PROCEDURE FACE WITH EAR LOOPS NON27378", "code_information": [{"code": "NON27378", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BIPAP AF531 NIVO LG FULL FACE 73-1072620EA", "code_information": [{"code": "73-1072620EA", "type": "CDM"}], "standard_charges": [{"gross_charge": 80.11, "discounted_cash": 21.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BIPAP AF531 NIVO MED FULL-FACE 73-1072619EA", "code_information": [{"code": "73-1072619EA", "type": "CDM"}], "standard_charges": [{"gross_charge": 80.11, "discounted_cash": 21.63, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BREATHING MED CONCENTRATION ELONGATED ANESTHESIA LF PEDI", "code_information": [{"code": "1042", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK BREATHING SZ 4 ANESTHESIA LF PEDI", "code_information": [{"code": "1045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.34, "discounted_cash": 1.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK CIRCUIT ANESTHESIA ADULT 72 SWIVEL W/GAS SAMPLING LINE 9177", "code_information": [{"code": "9177", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.47, "discounted_cash": 8.23, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ECTO2 POM 7FT O2 LINE MED CONCENT O2 ADAPTER SND LUER CAP DISP LF 301-0318LTEZ", "code_information": [{"code": "301-0318LTEZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.63, "discounted_cash": 9.89, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE CLR TENT UNDER THE CHIN DESIGN VINYL FOR HIGH HUMIDITY AEROSOL THERAPY", "code_information": [{"code": "1388", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.99, "discounted_cash": 1.62, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE REG SURG STRL ADLT DISP", "code_information": [{"code": "7210559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 220.32, "discounted_cash": 59.49, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE RESPIRATORY MD LG SECURE-GARD N95 LF FLUID RESPIRATOR CONE", "code_information": [{"code": "N95-ML", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 3 LARYNGEAL MASK AIRWAY FLEXIBLE", "code_information": [{"code": "327300000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.63, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 3 TODDLER BUBBLE GUM SCENT SWEET DREAMS PEDI", "code_information": [{"code": "1132", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.83, "discounted_cash": 1.84, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 4 LARYNGEAL MASK AIRWAY FLEXIBLE", "code_information": [{"code": "327400000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.63, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 5 LARYNGEAL MASK AIRWAY FLEXIBLE", "code_information": [{"code": "327500000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 59.63, "discounted_cash": 16.1, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK FACE SZ 5 MEDINFLATABLE LF ADLT", "code_information": [{"code": "1055", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.83, "discounted_cash": 1.57, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL AMBU AURAONCE PVC 15MM MALE CONNECTOR 22.5MM TUBE 40ML CUFF 5", "code_information": [{"code": "321 500 000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.4, "discounted_cash": 11.99, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL AURAONCE LATEX FREE PVC STERILE DISPOSABLE ADULT SIZE 4", "code_information": [{"code": "321 400 000U", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 44.4, "discounted_cash": 11.99, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SIZE 2 LMA LMA125020", "code_information": [{"code": "LMA125020", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 42.74, "discounted_cash": 11.54, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SUP AIRWAY STRL SZ 5 ALBF050SU", "code_information": [{"code": "ALBF050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.72, "discounted_cash": 12.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 2.5 CHILD LF", "code_information": [{"code": "ALAA025SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.97, "discounted_cash": 8.09, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 3 CHILD LF ALAA030SU", "code_information": [{"code": "ALAA030SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.97, "discounted_cash": 8.09, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LARYNGEAL SZ 5 ADULT LF ALAA050SU", "code_information": [{"code": "ALAA050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.97, "discounted_cash": 8.09, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA CUFF PILOT 1.0 SINGLE USE 105200-000010", "code_information": [{"code": "105200-000010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.14, "discounted_cash": 7.87, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA CUFF PILOT 2.5 SINGLE USE 105200 000025", "code_information": [{"code": "105200-000025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.75, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SUPREME SZ 5 HUDALBF050SU", "code_information": [{"code": "HUDALBF050SU", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 45.72, "discounted_cash": 12.34, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SZ 1.5 AMBU AURASTRAIGHT", "code_information": [{"code": "324150000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.8, "discounted_cash": 9.67, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SZ 2 AMBU AURAGAIN", "code_information": [{"code": "408200000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.02, "discounted_cash": 8.92, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SZ 2 AMBU AURASTRAIGHT", "code_information": [{"code": "324200000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.8, "discounted_cash": 9.67, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SZ 2.5 AMBU AURAGAIN", "code_information": [{"code": "408250000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 33.02, "discounted_cash": 8.92, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SZ 2.5 AMBU AURASTRAIGHT", "code_information": [{"code": "324250000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 35.8, "discounted_cash": 9.67, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SZ 3 AMBU AURASTRAIGHT", "code_information": [{"code": "324300000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.56, "discounted_cash": 7.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SZ 4 AMBU AURASTRAIGHT", "code_information": [{"code": "324400000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.56, "discounted_cash": 7.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK LMA SZ 5 AMBU AURASTRAIGHT", "code_information": [{"code": "324500000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.56, "discounted_cash": 7.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK MISTY NEB W/ MICRO MIST", "code_information": [{"code": "2032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.77, "discounted_cash": 1.29, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NEBULIZER 7FT W/ TUBING PEDI", "code_information": [{"code": "4486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.32, "discounted_cash": 1.98, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NEBULIZER KIT PEDIATRIC 7' UNIVERSAL CONNECTOR HCSU4486", "code_information": [{"code": "HCSU4486", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.72, "discounted_cash": 1.27, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NON-REBREATHER OXYGEN ADULT HUD1935", "code_information": [{"code": "HUD1935", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.55, "discounted_cash": 1.23, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK NON-REBREATHING ADULT 7 FT WITH THREADED NUT", "code_information": [{"code": "365", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.88, "discounted_cash": 2.13, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 ADULT CLR MED W/ 7FT TU", "code_information": [{"code": "1041", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 ADULT CLR NON REBREATHER SOFT VINYL W/ LOW RESISTANCE CHECK VALVES W/ 7FT OXYG", "code_information": [{"code": "1060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.8, "discounted_cash": 1.57, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 MED CONCENTRATION UNDER CHIN W/ 7FT TUBING LF PEDI", "code_information": [{"code": "1262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.16, "discounted_cash": 0.85, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 OXYMASK ADLT 7 UC", "code_information": [{"code": "OM-1125-8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 19.98, "discounted_cash": 5.39, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK O2 PED 7IN TUBING WITH THREADED NUT", "code_information": [{"code": "3222-E", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.55, "discounted_cash": 1.5, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN 3 IN 1 STYLE ADULT COMP U-CONNECT 001361", "code_information": [{"code": "1361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.61, "discounted_cash": 0.97, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN ELONGATED ADULT HUD1930", "code_information": [{"code": "HUD1930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN MED CONCEN PEDIATRIC 7' UC HCSU4601B", "code_information": [{"code": "HCSU4601B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.3, "discounted_cash": 0.89, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK OXYGEN NON REBREATHING ELONGATED ADLT DISP", "code_information": [{"code": "1059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.33, "discounted_cash": 2.25, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PRO2 OX ADL MED CONC 301-PRO2LTEZ", "code_information": [{"code": "301-PRO2LTEZ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 30.08, "discounted_cash": 8.12, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PROCEDURE SECURE GARD BLUE AT71021", "code_information": [{"code": "AT71021", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PUNCH CRUCIATE MICROPLASTY", "code_information": [{"code": "32-485511", "type": "CDM"}], "standard_charges": [{"gross_charge": 2640.0, "discounted_cash": 712.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PUNCH I BEAM MICROPLASTY", "code_information": [{"code": "32-485510", "type": "CDM"}], "standard_charges": [{"gross_charge": 2220.0, "discounted_cash": 599.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PUNCH SPLINED STEM MICROPLASTY", "code_information": [{"code": "32-484630", "type": "CDM"}], "standard_charges": [{"gross_charge": 2220.0, "discounted_cash": 599.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK PUNCH TIBIAL", "code_information": [{"code": "32-347525", "type": "CDM"}], "standard_charges": [{"gross_charge": 2634.0, "discounted_cash": 711.18, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK RESP N95 NIOSH APPROVED SMALL 1860S", "code_information": [{"code": "1860S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.22, "discounted_cash": 0.87, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK RESUSCITATOR 2600ML 40IN TUBING MED MASK SEBS W/ BAG SPUR II LF ADLT DISP", "code_information": [{"code": "520211000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 32.36, "discounted_cash": 8.74, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK RESUSCITATOR MED MASK PORT W/ BAG SPUR II LF ADLT DISP", "code_information": [{"code": "520611000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.08, "discounted_cash": 9.74, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK REV UNIVERSAL VANGUARD", "code_information": [{"code": "32-488510", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK STEM REV VANGUARD", "code_information": [{"code": "32-488511", "type": "CDM"}], "standard_charges": [{"gross_charge": 828.0, "discounted_cash": 223.56, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK TIBL STEMMED BIOMET 500", "code_information": [{"code": "32-347106", "type": "CDM"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK TRACHEOSTOMY ADJ STRP WITHOUT TUBING ADLT", "code_information": [{"code": "1075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "MASS SPECTROMETRY QUAL/QUAN", "code_information": [{"code": "83789", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RAD URBAN TYPE", "code_information": [{"code": "19306", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MAST RADICAL", "code_information": [{"code": "19305", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY", "code_information": [{"code": "19162", "type": "CPT"}, {"code": "1481285", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 10324.0, "discounted_cash": 2787.48, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MASTECTOMY FOR GYNECOMASTIA 19300", "code_information": [{"code": "19300", "type": "CPT"}, {"code": "2580862", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "gross_charge": 8313.0, "discounted_cash": 2244.51, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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"UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MDFC FLAP W/PRSRV VASC PEDCL", "code_information": [{"code": "15730", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE KIDNEY PRESSURE", "code_information": [{"code": "50396", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"billing_class": "facility"}]}, {"description": "MEASURE URETER PRESSURE", "code_information": [{"code": "50686", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURE VENOUS PRESSURE", "code_information": [{"code": "93770", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MEASURING DEVICE FOR 4.5MM HCS 03.226.030", "code_information": [{"code": "3.226.030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 959.54, "discounted_cash": 259.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36595", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECH REMOV TUNNELED CV CATH", "code_information": [{"code": "36596", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECHANICAL CHEST WALL OSCILL", "code_information": [{"code": "94669", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MECKELS DIVERT EXAM", "code_information": [{"code": "78290", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 372.68, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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{"description": "MED BARREL CUTTING BUR 4X10", "code_information": [{"code": "509154", "type": "CDM"}], "standard_charges": [{"gross_charge": 201.0, "discounted_cash": 54.27, "setting": "both", "billing_class": "facility"}]}, {"description": "MED NUTRITION INDIV SUBSEQ", "code_information": [{"code": "97803", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MED OVAL CUTTING BUR 4X8MM", "code_information": [{"code": "509136", "type": "CDM"}], "standard_charges": [{"gross_charge": 177.0, "discounted_cash": 47.79, "setting": "both", "billing_class": "facility"}]}, {"description": "MED OVAL CUTTING BUR 5.5X10MM", 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"setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.85, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS 1 STAGE H/N/HF/G", "code_information": [{"code": "17311", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS ADDL STAGE T/A/L", "code_information": [{"code": "17314", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOHS SURG ADDL BLOCK", "code_information": [{"code": "17315", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 166.68, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 5", "code_information": [{"code": "81404", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.35, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 6", 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"standard_charge_dollar": 254.59, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 8", "code_information": [{"code": "81407", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 761.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 9", "code_information": [{"code": "81408", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, 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"RC"}], "standard_charges": [{"gross_charge": 387.75, "discounted_cash": 104.69, "setting": "both", "billing_class": "facility"}]}, {"description": "MOTOBAND POLYAXIAL LOCKING SCREW 3.5MM X 14MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3514", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.5, "discounted_cash": 138.11, "setting": "both", "billing_class": "facility"}]}, {"description": "MOTOBAND POLYAXIAL LOCKING SCREW 3.5MM X 20MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15PL-3520", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.5, "discounted_cash": 138.11, "setting": "both", "billing_class": "facility"}]}, {"description": "MOTOCLIP FUSION SYSTEM 12X12X12MM SUPER ELASTIC", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1412-1212", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3300.0, "discounted_cash": 891.0, "setting": "both", "billing_class": "facility"}]}, {"description": "MOTOCLIP HIMAX 18X18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7118-1818", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4281.75, "discounted_cash": 1156.07, "setting": "both", "billing_class": "facility"}]}, {"description": "MOTOR &/ SENS NRVE CNDJ TEST", "code_information": [{"code": "95905", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MOTR COG VR GAIT TRAIN EA 15", "code_information": [{"code": "791T", "type": "CPT"}], "standard_charges": [{"minimum": 57.0, "maximum": 57.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOUNT BLOCK VANG TENSOR BLOCK MOUNT", "code_information": [{"code": "32-468542", "type": "CDM"}], "standard_charges": [{"gross_charge": 3054.0, "discounted_cash": 824.58, "setting": "both", "billing_class": "facility"}]}, {"description": "MOUTHPIECE NBLZR 10 ML 7FT TUBING STANDARD CONNECTOR SM VOLUME TEE ADAPTER AIRLI", "code_information": [{"code": "2435", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 1.08, "setting": "both", "billing_class": "facility"}]}, {"description": "MPL GENE COMMON VARIANTS", "code_information": [{"code": "81338", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 135.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MPL GENE SEQ ALYS EXON 10", "code_information": [{"code": "81339", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 166.68, "methodology": "fee 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"CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 511.18, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 297.07, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR ELASTOGRAPHY", "code_information": [{"code": "76391", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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"methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety determination by a physician or other qualified health care professional responsible for the safety of the MR procedure, including review of implant MR conditions for indicated MR examination, analysis of risk vs clinical benefit of performing M", "code_information": [{"code": "76016", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review o", "code_information": [{"code": "76014", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (eg, surgical reports, imaging reports, medical device databases, device vendors, review o", "code_information": [{"code": "76015", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety implant electronics preparation under supervision of physician or other qualified health care professional, including MR-specific programming of pulse generator and/or transmitter to verify device integrity, protection of device internal circuit", "code_information": [{"code": "76018", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR safety implant positioning and/or immobilization under supervision of physician or other qualified health care professional, including application of physical protections to secure implanted medical device from MR-induced translational or vibrational f", "code_information": [{"code": "76019", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MR 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Aspiration Renal Left 77021", "code_information": [{"code": "77021", "type": "CPT"}, {"code": "630775", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1667.0, "discounted_cash": 450.09, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 522.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 926.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Aspiration Renal Right 77021", "code_information": [{"code": "77021", "type": "CPT"}, {"code": "630779", "type": "CDM"}, {"code": "614", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1667.0, "discounted_cash": 450.09, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 522.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 926.85, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BRAIN W/DYE", "code_information": [{"code": "70558", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 264.55, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI BREAST C- UNILATERAL", "code_information": [{"code": "77046", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", 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payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Face Neck Orbit w/ + w/o Cont  70543", "code_information": [{"code": "70543", "type": "CPT"}, {"code": "630853", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3157.0, "discounted_cash": 852.39, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 806.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": 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{"code": "630857", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3157.0, "discounted_cash": 852.39, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 638.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1755.29, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 425.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Face Neck Orbit w/o Contrast  70540", "code_information": [{"code": "70540", "type": "CPT"}, {"code": "630859", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2152.0, "discounted_cash": 581.04, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 526.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1196.51, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 333.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/ + w/o Contrast Bilat  73720", "code_information": [{"code": "73720", "type": "CPT"}, {"code": "630861", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 6313.0, "discounted_cash": 1704.51, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 806.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3510.02, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 519.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 806.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1755.29, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 519.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/ Contrast Bilat 73719", "code_information": [{"code": "73719", "type": "CPT"}, {"code": "630867", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 6313.0, "discounted_cash": 1704.51, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 638.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3510.02, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 425.2, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 390.54, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/ Contrast Left 73719", "code_information": [{"code": "73719", "type": "CPT"}, {"code": "630869", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3157.0, "discounted_cash": 852.39, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/ Contrast Right 73719", "code_information": [{"code": "73719", "type": "CPT"}, {"code": "630871", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3157.0, "discounted_cash": 852.39, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 638.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1755.29, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 2394.69, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 333.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/o Contrast Left 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "630875", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2152.0, "discounted_cash": 581.04, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 526.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 1624.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 1196.51, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 333.92, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MRI Femur w/o Contrast Right 73718", "code_information": [{"code": "73718", "type": "CPT"}, {"code": "630877", "type": "CDM"}, {"code": "610", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 2152.0, "discounted_cash": 581.04, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 526.86, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, 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"billing_class": "facility"}]}, {"description": "MYD88 GENE P.LEU265PRO VRNT", "code_information": [{"code": "81305", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 157.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYELOGRAM TRAY", "code_information": [{"code": "225825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.65, "discounted_cash": 3.69, "setting": "both", "billing_class": "facility"}]}, {"description": "MYELOGRAPHY THORACIC SPINE", "code_information": [{"code": "72255", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 134.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 785.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1 STD W/CT", "code_information": [{"code": "78429", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 1STD RST/STRS", "code_information": [{"code": "78491", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1942.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER", "code_information": [{"code": "78432", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1961.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET 2RTRACER CT", "code_information": [{"code": "78433", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2067.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET MLT RST&STRS", "code_information": [{"code": "78492", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1942.7, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST&STRS CT", "code_information": [{"code": "78431", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2915.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET RST/STRS W/CT", "code_information": [{"code": "78430", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD IMG PET SINGLE STUDY", "code_information": [{"code": "78459", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1620.87, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1406.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOCRD STRAIN IMG SPCKL TRCK", "code_information": [{"code": "93356", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM COMPLEX", "code_information": [{"code": "58146", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY ABDOM METHOD", "code_information": [{"code": "58140", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MYOMECTOMY VAGINAL 250 G 58145", "code_information": [{"code": "58145", "type": "CPT"}, {"code": "1481307", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "gross_charge": 9530.0, "discounted_cash": 2573.1, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NASAL/SINUS ENDOSCOPY 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[{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDLE 18GX3.5 PINK HUB STRL SNGL USE 405184", "code_information": [{"code": "405184", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.43, "discounted_cash": 3.09, "setting": "both", "billing_class": "facility"}]}, {"description": "NDOVAG CRYG RF REMDL TISS", "code_information": [{"code": "672T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NDSC HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "33509", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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2079.0, "discounted_cash": 561.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NECK MODULAR 8DEG AV/RV 127DEG/132DEG 30MM GRAY REJUVENATE IMP", "code_information": [{"code": "NLV-300800G", "type": "CDM"}], "standard_charges": [{"gross_charge": 2079.0, "discounted_cash": 561.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NECK MODULAR 8DEG AV/RV 127DEG/132DEG 34MM YELLOW REJUVENATE IMP", "code_information": [{"code": "NLV-340800Y", "type": "CDM"}], "standard_charges": [{"gross_charge": 2079.0, "discounted_cash": 561.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NECK MODULAR 8DEG AV/RV 127DEG/132DEG 38MM YELLOW REJUVENATE IMP", "code_information": [{"code": "NLV-380800Y", "type": "CDM"}], "standard_charges": [{"gross_charge": 2079.0, "discounted_cash": 561.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NECK MODULAR 8DEG AV/RV 127DEG/132DEG 42MM YELLOW REJUVENATE IMP", "code_information": 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ADAPTER", "code_information": [{"code": "1601-2000", "type": "CDM"}], "standard_charges": [{"gross_charge": 105.0, "discounted_cash": 28.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 13G  RX COUDE EPIDURAL TW X 4.0 105-1315", "code_information": [{"code": "105-1315", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.8, "discounted_cash": 40.99, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 15G 24MM-48MM ADJ LENGTH DISP DIN1515X", "code_information": [{"code": "DIN1515X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 46.17, "discounted_cash": 12.47, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 18GX6 PINK HUB STRL SINGLE USE 408360", "code_information": [{"code": "408360", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.75, "discounted_cash": 7.49, "setting": "both", 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"standard_charges": [{"gross_charge": 4902.0, "discounted_cash": 1323.54, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22GX5 BLACK LONG STRL SINGLE USE 405148", "code_information": [{"code": "405148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.75, "discounted_cash": 7.49, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 22GX7 BLACK LONG STRL SINGLE 405149", "code_information": [{"code": "405149", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 22.64, "discounted_cash": 6.11, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX3.5 PNCL PT BL HIGH FLOW 405138", "code_information": [{"code": "405138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 38.68, "discounted_cash": 10.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 25GX3.5 SPINAL STERILE PENCAN", 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"billing_class": "facility"}]}, {"description": "NEEDLE 36MM RECSE CUTTING 1/2 CIRCLE W/LOOP AR-7280", "code_information": [{"code": "AR-7280", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.9, "discounted_cash": 20.49, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 6\" 8050363", "code_information": [{"code": "8050363", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 210.0, "discounted_cash": 56.7, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE 8G X 23CM OPEN TIP ASPIRATION  RAN-823-OT", "code_information": [{"code": "RAN-823-OT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2600.0, "discounted_cash": 702.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS 10GA IVAS", "code_information": [{"code": "306-530-000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 170.02, "discounted_cash": 45.91, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS INSUFFLATION 14G VERSA S100000", "code_information": [{"code": "S100000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.78, "discounted_cash": 27.21, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ACCESS INSUFFLATION 14G VERSASTEP VS150000", "code_information": [{"code": "VS150000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.53, "discounted_cash": 20.39, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ANES 17GA 5IN LNG LEN EPI THIN WALL MODIFIED POINT FIXED WINGS PERISAFE L", "code_information": [{"code": "405193", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1781.0, "discounted_cash": 480.87, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ANESTHESIA 25GA X 3.5IN BLUE SPINAL STRL DISP", "code_information": [{"code": "405180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.05, "discounted_cash": 2.17, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE APS DRY 0.25MM X 40MM A1042PD", "code_information": [{"code": "A1042PD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE ASPIRATION CLOSED-TIP 8G X 23CM RAN-823-CT", "code_information": [{"code": "RAN-823-CT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1072.5, "discounted_cash": 289.58, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BEVEL TIP 8G ASSEMBLY", "code_information": [{"code": "1001-90183", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 426.36, "discounted_cash": 115.12, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BEVELED JAMSHIDI", "code_information": [{"code": "RAN-815NRT-BEV", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1650.0, "discounted_cash": 445.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 14GA X 4.5IN TRU-CUT STRANDARD HANDLE CUTTINGEDGE THINWALL SOFT TI", "code_information": [{"code": "2N2702X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.12, "discounted_cash": 18.66, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 16GA X 20CM MONOPTY CORE 22MM PENETRATION  PURPLE", "code_information": [{"code": "121620", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 323.0, "discounted_cash": 87.21, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 18G X 250MM 28-BG1825", "code_information": [{"code": "28-BG1825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.25, "discounted_cash": 23.29, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 18GA 3.5 CMINTRAOSSEOUSINFUSION ILLINOIS LANCET POINT BONE MARROW", "code_information": [{"code": "DIN1518X", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.41, "discounted_cash": 13.34, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY 22GA X 8IN CHIBA FINE NDL THIN WALL STRL", "code_information": [{"code": "B-D408269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.2, "discounted_cash": 6.26, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY CHEST LINING", "code_information": [{"code": "32400", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY PANCREAS", "code_information": [{"code": "48102", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEEDLE BIOPSY SPINOPLASTY LONG 11G X 15CM G13020", "code_information": [{"code": "G13020", "type": 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"discounted_cash": 9.07, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE CHOLANGIOGRAPHY 22G X 8", "code_information": [{"code": "408269", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.2, "discounted_cash": 6.26, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COOK JAMSHIDI BIOPSY  G12374", "code_information": [{"code": "G12374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 272.0, "discounted_cash": 73.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COUDE 18G RX2", "code_information": [{"code": "107-1418", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 9.47, "discounted_cash": 2.56, "setting": "both", "billing_class": "facility"}]}, {"description": "NEEDLE COUDE 20G X 203MM", "code_information": [{"code": "122-2080", "type": "CDM"}, {"code": "272", "type": "RC"}], 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CM 97605", "code_information": [{"code": "97605", "type": "CPT"}, {"code": "11054962", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 187.0, "discounted_cash": 50.49, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEGATIVE PRESSURE WOUND THERAPY W/DISPOSAL MED.EQUIP. W/TOPICAL APP. 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{"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.35, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLY/DEX (MAXITROL) OPHTHALMIC OINTMENT 3.5GM", "code_information": [{"code": "MED0157", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 75.04, "discounted_cash": 20.26, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLY/HYDROCORT 1% 10ML OTIC SOLUTION/ CORTISPORIN", "code_information": [{"code": "MED0158", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 196.38, "discounted_cash": 53.02, "setting": "both", "billing_class": "facility"}]}, {"description": "NEO/POLYMYXIN/BACITRACIN (NEOSPORIN) OINT 15GM", "code_information": [{"code": "MED0159", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 8.59, "discounted_cash": 2.32, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOGUARD  TRANSDUCER COVER", "code_information": [{"code": "610-1038", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 21.87, "discounted_cash": 5.9, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLYMIXIN B SULFATE IRRIGATION 1 ML", "code_information": [{"code": "MED0231", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 41.71, "discounted_cash": 11.26, "setting": "both", "billing_class": "facility"}]}, {"description": "NEOMYCIN/POLYMYXIN/DEXAMTHASONE JELLY", "code_information": [{"code": "MED0161", "type": "CDM"}], "standard_charges": [{"gross_charge": 64.33, "discounted_cash": 17.37, "setting": "both", "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE INITIAL", "code_information": [{"code": "99468", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEONATE CRIT CARE SUBSQ", "code_information": [{"code": "99469", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [{"code": "794", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3869.0, "maximum": 3869.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3869.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [{"code": "789", "type": "MS-DRG"}], "standard_charges": [{"minimum": 3869.0, "maximum": 3869.0, "setting": "inpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3869.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "NEPHROTOMY W/EXPLORATION", "code_information": [{"code": "50045", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, 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"code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "AGX210", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2550.0, "discounted_cash": 688.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NERVE CONNECTOR AXOGUARD 2MM X 15MM", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "AGX215", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6420.0, "discounted_cash": 1733.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NERVE CONNECTOR AXOGUARD 2MM X 16MM", "code_information": [{"code": "Q4100", "type": "HCPCS"}, {"code": "AGX216", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 3825.0, "discounted_cash": 1032.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NERVE CONNECTOR AXOGUARD 6 X 15MM", "code_information": [{"code": "C9361", "type": "HCPCS"}, {"code": "AGX615", "type": "CDM"}, 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE GRAFT HEAD/NECK >4 CM", "code_information": [{"code": "64886", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PEDICLE TRANSFER", "code_information": [{"code": "64907", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NERVE PROTECTOR AXOGVARD 20 X 20", "code_information": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AA&/STRD VAGUS NRV", "code_information": [{"code": "64408", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX AUTOL WBC CONCENTRATE", "code_information": [{"code": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NJX SCLRSNT MLT INCMPTNT VN", "code_information": [{"code": "36471", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 33.96, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NKII DURASUL ULTRA CONG TIB INS RT  SZ 00/0  13MM 627600713", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "627600713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2250.0, "discounted_cash": 607.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NL COMP CGEN KDN ABNORMALITY", "code_information": [{"code": "50070", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL RMVL LG STAGHORN CALCULUS", "code_information": [{"code": "50075", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NL SEC SURG OPERJ CALCULUS", "code_information": [{"code": "50065", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM", "code_information": [{"code": "5537-G-111", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM", "code_information": [{"code": "5537-G-113", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM", "code_information": [{"code": "5537-G-116", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-119", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM", "code_information": [{"code": "5537-G-122", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM", "code_information": [{"code": "5537-G-125", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-128", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8854.2, "discounted_cash": 2390.63, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM", "code_information": [{"code": "5537-G-131", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 1. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 9MM", "code_information": [{"code": "5537-G-109", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-213", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-222", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8298.0, "discounted_cash": 2240.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM", "code_information": [{"code": "5537-G-228", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM", "code_information": [{"code": "5537-G-231", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 2. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-209", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7822.8, "discounted_cash": 2112.16, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-311", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-316", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-319", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8613.0, "discounted_cash": 2325.51, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-322", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7979.4, "discounted_cash": 2154.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-325-E", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7979.4, "discounted_cash": 2154.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-331", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 3. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-309", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-411", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7979.4, "discounted_cash": 2154.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-413", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8298.0, "discounted_cash": 2240.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-422", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM", "code_information": [{"code": "5537-G-425", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-428", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM", "code_information": [{"code": "5537-G-431", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 4. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-409", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7822.8, "discounted_cash": 2112.16, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-516", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8854.2, "discounted_cash": 2390.63, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-525", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7522.2, "discounted_cash": 2030.99, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8298.0, "discounted_cash": 2240.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 5. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-531", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-619", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8298.0, "discounted_cash": 2240.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-622", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8613.0, "discounted_cash": 2325.51, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-625", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8613.0, "discounted_cash": 2325.51, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-628", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM", "code_information": [{"code": "5537-G-631", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 6. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 9MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-609", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-711", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7979.4, "discounted_cash": 2154.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-716", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-719", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 22MM", "code_information": [{"code": "5537-G-722", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 25MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 28MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-728", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8298.0, "discounted_cash": 2240.46, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 7. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 31MM", "code_information": [{"code": "5537-G-731", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 11MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-813", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 16MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5537-G-816", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7979.4, "discounted_cash": 2154.44, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 8. TRIATHLON TS PLUS TIBIAL INSERT X3 POLY 19MM", "code_information": [{"code": "5537-G-819", "type": "CDM"}], "standard_charges": [{"gross_charge": 6785.7, "discounted_cash": 1832.14, "setting": "both", "billing_class": "facility"}]}, {"description": "NO 8. 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOT W/SPHENDT", "code_information": [{"code": "31257", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC TOTAL", "code_information": [{"code": "31253", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINS NDSC W/PRTL ETHMDCT", "code_information": [{"code": "31254", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS ENDOSCOPY SURG DCR", "code_information": [{"code": "31239", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SINUS NDSC RF ABLTJ PNN", "code_information": [{"code": "31242", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC CNCH BULL RESCJ", "code_information": [{"code": "31240", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NSL/SNS NDSC LIG SPHNPTN ART", "code_information": [{"code": "31241", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTIOL CATEGORY 4", "code_information": [{"code": "Q1004", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTIOL CATEGORY 5", "code_information": [{"code": "Q1005", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAOP HIPEC PX EA ADD 30MIN", "code_information": [{"code": "96548", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRAPX C FFR W/3D FUNCJL MAP", "code_information": [{"code": "523T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 1810.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK TRANSLOCATION ANALYSIS", "code_information": [{"code": "81194", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 466.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK1 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81191", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK2 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81192", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRK3 TRANSLOCATION ANALYSIS", "code_information": [{"code": "81193", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 186.58, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 11-20", "code_information": [{"code": "99447", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 21-30", "code_information": [{"code": "99448", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 31/>", "code_information": [{"code": "99449", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 5-10", "code_information": [{"code": "99446", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR 5/>", "code_information": [{"code": "99451", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTRPROF PH1/NTRNET/EHR RFRL", "code_information": [{"code": "99452", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR CPLX", "code_information": [{"code": "77386", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NTSTY MODUL RAD TX DLVR SMPL", "code_information": [{"code": "77385", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUBHVL XM PHY/QHP EA ADDL HR", "code_information": [{"code": "96121", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 16.14, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR EXAM OF TEAR FLOW", "code_information": [{"code": "78660", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 202.01, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR MATRIX PROTEIN 22", "code_information": [{"code": "86386", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 19.6, "methodology": "fee schedule"}], "billing_class": 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"plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 264.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX IV ADMIN", "code_information": [{"code": "79101", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 90.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 264.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEAR RX ORAL ADMIN", "code_information": [{"code": "79005", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 83.21, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 264.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUCLEUS SZ 1 SIMPLICITI SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10611.0, "discounted_cash": 2864.97, "setting": "both", "billing_class": "facility"}]}, {"description": "NUCLEUS SZ 3 SIMPLICITI SHOULDER", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWG403", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9624.0, "discounted_cash": 2598.48, "setting": "both", "billing_class": "facility"}]}, {"description": "NUCLR RX INTERSTIT COLLOID", "code_information": [{"code": "79300", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 131.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 264.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUDT15 GENE COMMON VARIANTS", "code_information": [{"code": "81306", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 262.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUEROFLEX 6.0MM", "code_information": [{"code": "C9355", "type": "HCPCS"}, {"code": "CNCF6025", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3984.0, "discounted_cash": 1075.68, "setting": "both", "billing_class": "facility"}]}, {"description": "NUEROSTIMILATOR KIT PATIENT TD2 PERM  74011", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "74011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3150.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99379", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NURSING FAC CARE SUPERVISION", "code_information": [{"code": "99380", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NUT COMPRESSION FOR ANKLE ARTHRODESIS NAIL SYS TRAY LAYOUT PHOENIX IMP", "code_information": [{"code": "14-440056", "type": "CDM"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 344.25, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT CONDYLE SCREW 5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1895-5001s", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 579.84, "discounted_cash": 156.56, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT CONNECTING SHRT M8", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4933-1-010", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 58.32, "discounted_cash": 15.75, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT CONNECTION M6 BOLT STRUT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4933-1-702", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 60.48, "discounted_cash": 16.33, "setting": "both", "billing_class": "facility"}]}, {"description": "NUT EX FIX CONNECTING M8 LONG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "4933-1-011", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 84.0, "discounted_cash": 22.68, "setting": "both", "billing_class": "facility"}]}, {"description": "NVR CNDJ TST 1-2 STUDIES", "code_information": [{"code": "95907", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Needle Biopsy Of Lung Or Chest Tissue, Accessed Through The Skin", "code_information": [{"code": "32405", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Needle EMG 2 extr w/wo paraspinal 95861", "code_information": [{"code": "95861", "type": "CPT"}, {"code": "10122570", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Needle EMG cranial nerve unilal 95867", "code_information": [{"code": "95867", "type": "CPT"}, {"code": "2616137", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1176.0, "discounted_cash": 317.52, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Needle electromyography; 4 extremities with or without related paraspinal areas  95864", "code_information": [{"code": "95864", "type": "CPT"}, {"code": "32615032", "type": "CDM"}, {"code": "922", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 1131.0, "discounted_cash": 305.37, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Negative pressure wound therapy (eg, vacuum assisted drainage collection) 97605", "code_information": [{"code": "97605", "type": "CPT"}, {"code": "1857286", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 97.0, "discounted_cash": 26.19, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neurofilament light chain (NfL)", "code_information": [{"code": "83884", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neuromuscular Reeducation Charges", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "752348", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 111.0, "discounted_cash": 29.97, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Neuromuscular Reeducation Charges - PTA", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "45575349", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 111.0, "discounted_cash": 29.97, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 1 Hour", "code_information": [{"code": "99327", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 20 Minutes", "code_information": [{"code": "99324", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 30 Minutes", "code_information": [{"code": "99325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 45 Minutes", "code_information": [{"code": "99326", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Custodial Care Facility, Group Care, Or Assisted Living Visit, Typically 75 Minutes", "code_information": [{"code": "99328", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Home Visit, Typically 45 Minutes", "code_information": [{"code": "99343", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "New Patient Office Or Other Outpatient Visit, Typically 10 Minutes", "code_information": [{"code": "99201", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "No Preference Card Available", "code_information": [{"code": "SNPC99999", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "No implantable/insertable device used with device-intensive procedures C1890", "code_information": [{"code": "C1890", "type": "HCPCS"}, {"code": "45664336", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "Nsl/sins cryo post nasal tis", "code_information": [{"code": "C9771", "type": "HCPCS"}], "standard_charges": [{"minimum": 13461.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine Study Of Red Blood Cell, Red Cell Survival, Organ Specific", "code_information": [{"code": "78135", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 427.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, Diagnostic", "code_information": [{"code": "341", "type": "RC"}], "standard_charges": [{"minimum": 530.0, "maximum": 1484.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1484.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 530.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, General Classification", "code_information": [{"code": "340", "type": "RC"}], "standard_charges": [{"minimum": 530.0, "maximum": 1484.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1484.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 530.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, Other", "code_information": [{"code": "349", "type": "RC"}], "standard_charges": [{"minimum": 530.0, "maximum": 1484.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1484.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 530.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nuclear Medicine, Therapeutic", "code_information": [{"code": "342", "type": "RC"}], "standard_charges": [{"minimum": 530.0, "maximum": 1484.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1484.0, "methodology": "case rate"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 530.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Nursery Newborn Level IV", "code_information": [{"code": "174", "type": "RC"}], "standard_charges": [{"minimum": 2100.0, "maximum": 2100.0, "setting": "outpatient", "payers_information": [{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 2100.0, "methodology": "per diem"}], "billing_class": "facility"}]}, {"description": "Nursing Facility Annual Assessment, Typically 30 Minutes", "code_information": [{"code": "99318", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US < 14 WKS ADDL FETUS", "code_information": [{"code": "76802", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 42.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US >= 14 WKS ADDL FETUS", "code_information": [{"code": "76810", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 69.88, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US DETAILED ADDL FETUS", "code_information": [{"code": "76812", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 94.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US FOLLOW-UP PER FETUS", "code_information": [{"code": "76816", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OB US NUCHAL MEAS 1 GEST", "code_information": [{"code": "76813", "type": "CPT"}], 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[{"gross_charge": 544.5, "discounted_cash": 147.02, "setting": "both", "billing_class": "facility"}]}, {"description": "OBTURATOR ARTHROSCOPIC PENCIL TIP DILATOR FOR 5.8 MM CANNULA", "code_information": [{"code": "747-031-510", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 472.5, "discounted_cash": 127.58, "setting": "both", "billing_class": "facility"}]}, {"description": "OBTURATOR ENDO 5MM SEALED RIGHT VERSAPORT V2 STRL DISP", "code_information": [{"code": "179101", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.79, "discounted_cash": 53.67, "setting": "both", "billing_class": "facility"}]}, {"description": "OBTURATOR VERSAPORT PLUA 12MM VZ RT SEAL", "code_information": [{"code": "179103P", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.54, "discounted_cash": 68.46, "setting": "both", "billing_class": "facility"}]}, {"description": "OCCLUDE FALLOPIAN TUBE(S)", "code_information": [{"code": "58615", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCCLUSIVE DEVICE IN VEIN ART", "code_information": [{"code": "G0269", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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"OCCULT BLOOD OTHER SOURCES", "code_information": [{"code": "82271", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4.79, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OCT BREAST SURG CAVITY I&R", "code_information": [{"code": "354T", "type": "CPT"}], "standard_charges": [{"minimum": 418.48, "maximum": 418.48, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 418.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN BOWEL TO SKIN", "code_information": [{"code": "44300", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN CHEST HEART MASSAGE", "code_information": [{"code": "32160", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN CORONARY ENDARTERECTOMY", "code_information": [{"code": "33572", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN DRAINAGE LIVER LESION", "code_information": [{"code": "47010", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN EXC CERV NODE(S) W/ ID", "code_information": [{"code": "C7503", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 4876.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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HRV UXTR ART 1 SGM CAB", "code_information": [{"code": "35600", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37237", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN/PERQ PLACE STENT EA ADD", "code_information": [{"code": "37239", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee 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STENT SAME", "code_information": [{"code": "37238", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPENER CORTICAL 4.5MM AO FITTING", "code_information": [{"code": "703543", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 762.3, "discounted_cash": 205.82, "setting": "both", "billing_class": "facility"}]}, {"description": "OPH US DX ANT SGM US UNI/BI", "code_information": [{"code": "76513", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 58.19, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPH US DX B-SCAN&QUAN A-SCAN", "code_information": [{"code": "76510", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 102.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC BIOMETRY", "code_information": [{"code": "92136", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMIC ENDOSCOPE ADD-ON", "code_information": [{"code": "66990", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPHTHALMODYNAMOMETRY", "code_information": [{"code": "92260", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPIATES 1 OR MORE", "code_information": [{"code": "80361", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN AX/SUBCLA ART EXPOS CNDT", "code_information": [{"code": "34716", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPN ILIAC ART EXPOS", "code_information": [{"code": "34820", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ORBITOCRANIAL APPROACH/SKULL", "code_information": 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"type": "HCPCS"}, {"code": "16164965", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CM At least 80% but less than 100% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164964", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Memory Discharge Status G-9170 -> CN 100% impaired", "code_information": [{"code": "G9170", "type": "HCPCS"}, {"code": "16164963", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"gross_charge": 0.01, "setting": "both", "billing_class": "facility"}]}, {"description": "OT Neuromuscular Reeducation Charges", "code_information": [{"code": "97112", "type": "CPT"}, {"code": "750905", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": 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"gross_charge": 48.0, "discounted_cash": 12.96, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Paraffin bath -> Yes", "code_information": [{"code": "97018", "type": "CPT"}, {"code": "1653304", "type": "CDM"}, {"code": "420", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 48.0, "discounted_cash": 12.96, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 145.0, "discounted_cash": 39.15, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Self Care Charges", "code_information": [{"code": "97535", "type": "CPT"}, {"code": "1646832", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 122.0, "discounted_cash": 32.94, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case 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"billing_class": "facility"}]}, {"description": "OT Sensory Integration Minutes", "code_information": [{"code": "97533", "type": "CPT"}, {"code": "1646829", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 111.0, "discounted_cash": 29.97, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Therapeutic Activities Charges", "code_information": [{"code": "97530", "type": "CPT"}, {"code": "750903", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 111.0, "discounted_cash": 29.97, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Therapeutic Exercise Charges", "code_information": [{"code": "97110", "type": "CPT"}, {"code": "750901", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 111.0, "discounted_cash": 29.97, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Ultrasound Charges", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "1017869", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 83.0, "discounted_cash": 22.41, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Ultrasound Minutes", "code_information": [{"code": "97035", "type": "CPT"}, {"code": "1646842", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 83.0, "discounted_cash": 22.41, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Unlisted Physical Medicine Procedure 97799", "code_information": [{"code": "97799", "type": "CPT"}, {"code": "1560028", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 114.0, "discounted_cash": 30.78, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OT Vasopneumatic Device -> Yes", "code_information": [{"code": "97016", "type": "CPT"}, {"code": "1647286", "type": "CDM"}, {"code": "430", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 43.0, "discounted_cash": 11.61, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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5454.0, "gross_charge": 62.0, "discounted_cash": 16.74, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OTHER BONE GRAFT MICROVASC", "code_information": [{"code": "20962", "type": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PABPN1 GENE DETC ABNOR ALLEL", "code_information": [{"code": "81312", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PACK  DENTAL AMBULATORY BXTEN4154903", "code_information": [{"code": "BXTEN4154903", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.04, "discounted_cash": 24.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROPLASTY CMC ASCENSION DISP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CMC-DIS-STR", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1305.0, "discounted_cash": 352.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPE HIP W/ THREE GUIDEWIRES AND 2 ARTHROSCOPY NDLS STRL DISP", "code_information": [{"code": "7209874", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 778.37, "discounted_cash": 210.16, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY", "code_information": [{"code": "DYNJ35500", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.7, "discounted_cash": 67.96, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CDS", "code_information": [{"code": "CDS981747F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 205.07, "discounted_cash": 55.37, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CDS DBD", "code_information": [{"code": "CDS981747", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CUSTOM CARDINAL VER 5 PO41AAOK5", "code_information": [{"code": "PO41AAOK5", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 302.33, "discounted_cash": 81.63, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CUSTOM CARDINAL VER 6 PO41AAOK6", "code_information": [{"code": "PO41AAOK6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.97, "discounted_cash": 89.09, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CUSTOM CARDINAL VER 7 PO41AAOK7", "code_information": [{"code": "PO41AAOK7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.8, "discounted_cash": 89.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CUSTOM CARDINAL VER E PO41AAOKE", "code_information": [{"code": "PO41AAOKE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CUSTOM CARDINAL VER G PO41AAOKG", "code_information": [{"code": "PO41AAOKG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.97, "discounted_cash": 89.09, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CUSTOM OCOM", "code_information": [{"code": "DYNJ37464A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 254.33, "discounted_cash": 68.67, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY CUSTOM OCOM NORTH SOP41ASOCE", "code_information": [{"code": "SOP41ASOCE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 229.4, "discounted_cash": 61.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY SHOULDER HT99ORAR3A", "code_information": [{"code": "HT99ORAR3A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.75, "discounted_cash": 34.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY SHOULDER STANDARD DYNJS3065", "code_information": [{"code": "DYNJS3065", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 329.6, "discounted_cash": 88.99, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY SOP41ASOC2", "code_information": [{"code": "SOP41ASOC2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 214.23, "discounted_cash": 57.84, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ARTHROSCOPY USPI OCOM NORTH SOP41ASOCB", "code_information": [{"code": "SOP41ASOCB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.09, "discounted_cash": 63.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK BLADE EZOUT 52MM 7812-052-001K", "code_information": [{"code": "7812-052-001K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3287.93, "discounted_cash": 887.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK BLADE EZOUT 62MM 7812-062-001K", "code_information": [{"code": "7812-062-001K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3287.93, "discounted_cash": 887.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK BUR BONE SAW MCP PYRO CARBON TOTAL JOINT COMMAND II TPS MICRO DRILL", "code_information": [{"code": "MCP-DIS-STR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1237.5, "discounted_cash": 334.13, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CATARACT CUSTOM", "code_information": [{"code": "CMP1217", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 100.4, "discounted_cash": 27.11, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK COLD INSTANT HEAVY-WEIGHT 6X10 MDS138000", "code_information": [{"code": "MDS138000", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK COLD SHOULDER", "code_information": [{"code": "DK20", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 210.63, "discounted_cash": 56.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CONVENIENCE 50MM IMPLANT BIO TRANSFIX", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1351LBK-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3000.0, "discounted_cash": 810.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CONVENIENCE MPFL MEDIAL PATELLOFEMORAL LIGAMENT", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1360B-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4137.0, "discounted_cash": 1116.99, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CONVENIENCE TIGHTROPE MEDIAL PATELLOFEMORAL LIGAMENT ANTERIOR CRUCIATE LIGAMENT BIOCOMPOSITE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-1360CST-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5061.0, "discounted_cash": 1366.47, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ARTHROSCOPY CARDINAL OCOMN", "code_information": [{"code": "SOP41ASOCA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 213.01, "discounted_cash": 57.51, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ARTHROSCOPY CARDINAL OCOMS", "code_information": [{"code": "PO41AAOKA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 479.01, "discounted_cash": 129.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ARTHROSCOPY CARDINAL SOP41ASOCC", "code_information": [{"code": "SOP41ASOCC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.46, "discounted_cash": 64.11, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ARTHROSCOPY OCOM NORTH SOP41ASOCD", "code_information": [{"code": "SOP41ASOCD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.36, "discounted_cash": 62.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ARTHROSCOPY OCOMN", "code_information": [{"code": "DYNJ37464", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 215.36, "discounted_cash": 58.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ARTHROSCOPY OCOMS VER 1", "code_information": [{"code": "PO41AAOK1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.83, "discounted_cash": 83.92, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM ARTHROSCOPY OCOMS VER 2", "code_information": [{"code": "PO41AAOK2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 310.73, "discounted_cash": 83.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM EXTREMITY CARDINAL OCOMN", "code_information": [{"code": "SOP41EXOCA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.73, "discounted_cash": 40.97, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM EXTREMITY CARDINAL OCOMS", "code_information": [{"code": "PO41EXOKA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 222.41, "discounted_cash": 60.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM EXTREMITY CARDINAL SOP41EXOCB", "code_information": [{"code": "SOP41EXOCB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 155.11, "discounted_cash": 41.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM EXTREMITY LF OCOM", "code_information": [{"code": "DYNJ37468C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 256.37, "discounted_cash": 69.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM EXTREMITY OCOM VERSION 1", "code_information": [{"code": "PO41EXOK1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.37, "discounted_cash": 59.23, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM GYN DR. WEBSTER", "code_information": [{"code": "SMA41HSNBA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 110.95, "discounted_cash": 29.96, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM HAND CARDINAL SOP41HDOCD", "code_information": [{"code": "SOP41HDOCD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 140.21, "discounted_cash": 37.86, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM HAND OCOM", "code_information": [{"code": "DYNJ43967A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 291.87, "discounted_cash": 78.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAP CHOLE", "code_information": [{"code": "LCB52S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 816.48, "discounted_cash": 220.45, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAPAROTOMY CARDINAL OCOMS", "code_information": [{"code": "PG41LPOKA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.55, "discounted_cash": 43.89, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAPAROTOMY CARDINAL OCOMS VERSION 1", "code_information": [{"code": "PG41LPOK1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.21, "discounted_cash": 49.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAPAROTOMY CARDINAL OCOMS VERSION 2", "code_information": [{"code": "PG41LPOK2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.31, "discounted_cash": 49.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM LAPAROTOMY OCOM", "code_information": [{"code": "DYNJ901444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 223.04, "discounted_cash": 60.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM MINOR CARDINAL OCOMN", "code_information": [{"code": "SBA41MNOCA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 125.51, "discounted_cash": 33.89, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PLASTIC CARDINAL OCOMS", "code_information": [{"code": "PW41PLOKA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 282.64, "discounted_cash": 76.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM PLASTIC OCOM", "code_information": [{"code": "DYNJ901447", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 389.64, "discounted_cash": 105.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER CARDINAL OCOMN", "code_information": [{"code": "SOP41SDOCA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 157.04, "discounted_cash": 42.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER CARDINAL OCOMS", "code_information": [{"code": "PO41SHOKA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 255.1, "discounted_cash": 68.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER CARDINAL OCOMS VER 1", "code_information": [{"code": "PO41SHOK1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 250.24, "discounted_cash": 67.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER CARDINAL OCOMS VER 2 PO41SHOK2", "code_information": [{"code": "PO41SHOK2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 261.19, "discounted_cash": 70.52, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER CARDINAL OCOMS VER B", "code_information": [{"code": "PO41SHOKB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 253.44, "discounted_cash": 68.43, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER OCOMN SOP41SDOCB", "code_information": [{"code": "SOP41SDOCB", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 184.35, "discounted_cash": 49.77, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SHOULDER OCOMN SOP41SDOCC", "code_information": [{"code": "SOP41SDOCC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 173.74, "discounted_cash": 46.91, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SPINE OCOM", "code_information": [{"code": "DYNJ901445", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 540.39, "discounted_cash": 145.91, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM SURG MINOR", "code_information": [{"code": "DYNJ25803F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 263.93, "discounted_cash": 71.26, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL HIP CARDINAL OCOMS", "code_information": [{"code": "PO41THOKA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 712.47, "discounted_cash": 192.37, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL HIP CARDINAL OCOMS VER 1", "code_information": [{"code": "PO41THOK1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 682.14, "discounted_cash": 184.18, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL HIP OCOM", "code_information": [{"code": "DYNJ901446", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 825.96, "discounted_cash": 223.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL KNEE CDS", "code_information": [{"code": "CDS981745D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1303.27, "discounted_cash": 351.88, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL KNEE PO41TKOKJ", "code_information": [{"code": "PO41TKOKJ", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 840.35, "discounted_cash": 226.89, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK CUSTOM TOTAL KNEE W/O BOWL CARDINAL", "code_information": [{"code": "PO41TKOK1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 725.24, "discounted_cash": 195.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK DART-FREE EDGE INST PACK 2.5MM HEADLESS D0025000", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "D0025000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 53.46, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK DENTAL CUSTOM SW AMBULATORY DEN4154902", "code_information": [{"code": "DEN4154902", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 89.04, "discounted_cash": 24.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK DENTAL CUSTOM SW AMBULATORY DEN415490A", "code_information": [{"code": "DEN415490A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 78.38, "discounted_cash": 21.16, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK DRILL BITS/ GUIDEWIRES INTEGRA/STRYKER DISP", "code_information": [{"code": "PIP-D18-STR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1511.4, "discounted_cash": 408.08, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ENDOBUTTON CL ULTRA PAC 1.2", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "72202799", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 995.28, "discounted_cash": 268.73, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ENDOSCOPY PROCEDURE CUSTOM CEK-887-20", "code_information": [{"code": "CEK-887-20", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.08, "discounted_cash": 18.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY", "code_information": [{"code": "DYNJ25804D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.7, "discounted_cash": 24.49, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CDS", "code_information": [{"code": "CDS981746D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 424.35, "discounted_cash": 114.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CDS DBD", "code_information": [{"code": "CDS981746", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CUSTOM CARDINAL VERSION H PO41EXOKH", "code_information": [{"code": "PO41EXOKH", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 325.86, "discounted_cash": 87.98, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CUSTOM OCOM NORTH SOP41EXOCC", "code_information": [{"code": "SOP41EXOCC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 237.05, "discounted_cash": 64.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY CUSTOM VERSION G PO41EXOKG", "code_information": [{"code": "PO41EXOKG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 326.67, "discounted_cash": 88.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY NORTH SUB SOP41EXOC4", "code_information": [{"code": "SOP41EXOC4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 138.21, "discounted_cash": 37.32, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY OCOM NORTH - SUB 5 SOP41EXOC5", "code_information": [{"code": "SOP41EXOC5", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 137.69, "discounted_cash": 37.18, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY OCOMN", "code_information": [{"code": "DYNJ37468A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 200.57, "discounted_cash": 54.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY SOP41EXOC8", "code_information": [{"code": "SOP41EXOC8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.72, "discounted_cash": 36.64, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY SOP41EXOC9", "code_information": [{"code": "SOP41EXOC9", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 135.72, "discounted_cash": 36.64, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY SUB6 SOP41EXOC6", "code_information": [{"code": "SOP41EXOC6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 137.69, "discounted_cash": 37.18, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EXTREMITY USPI OCOM NORTH SUB7 SOP41EXOC7", "code_information": [{"code": "SOP41EXOC7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 139.1, "discounted_cash": 37.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK EYE CATARACT CUSTOM OKLA", "code_information": [{"code": "DYNJ37573B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 77.83, "discounted_cash": 21.01, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FILM 3IN X 5IN BIORESORBABLE HYCLORONIC ACID SUPRAFILM", "code_information": [{"code": "5086-02", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 425.0, "discounted_cash": 114.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 1.2CC ALLOGRAFT VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-1601", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 1.2CC COMPRESSION RESISTANT VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-1401", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 344.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 10CC BONE IMPLANT COMPRESSION RESISTANT BA2X VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10494.0, "discounted_cash": 2833.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 2.5CC VISTOSS BA", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-1602", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3414.0, "discounted_cash": 921.78, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 2.5CC VITOSS BA2X", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2102", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3807.0, "discounted_cash": 1027.89, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 5CC ALLOGRAFT VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-1605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6498.0, "discounted_cash": 1754.46, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM 5CC VITOSS", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2105", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7722.0, "discounted_cash": 2084.94, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM VITOSS 10CC", "code_information": [{"code": "C9362", "type": "HCPCS"}, {"code": "2102-1410", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6402.0, "discounted_cash": 1728.54, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK FOAM VITOSS BBTRAUMA 2.5CC", "code_information": [{"code": "C1763", "type": "HCPCS"}, {"code": "2102-2202", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3525.0, "discounted_cash": 951.75, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK GUIDE WIRE  PERCUPLASTY SN33", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SN33", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1050.0, "discounted_cash": 283.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND CUSTOM", "code_information": [{"code": "DYNJ43967", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 169.53, "discounted_cash": 45.77, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND CUSTOM OCOM NORTH SOP41HDOCE", "code_information": [{"code": "SOP41HDOCE", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 151.49, "discounted_cash": 40.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND CUSTOM VERSION C SOP41HPOKC", "code_information": [{"code": "SOP41HPOKC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 233.89, "discounted_cash": 63.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND SOP41HDOC6", "code_information": [{"code": "SOP41HDOC6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 36.72, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND SOP41HDOC7", "code_information": [{"code": "SOP41HDOC7", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.03, "discounted_cash": 36.19, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND SOP41HDOC8", "code_information": [{"code": "SOP41HDOC8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 134.03, "discounted_cash": 36.19, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HAND USPI OCOM NORTH SOP41HDOC5", "code_information": [{"code": "SOP41HDOC5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.0, "discounted_cash": 36.72, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK HYDRA-HEAT STD 12X10 HP1210-ST", "code_information": [{"code": "HP1210-ST", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 124.03, "discounted_cash": 33.49, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ICE 5IN X 12IN FACIAL BILATERAL ONE STRP STAY DRY", "code_information": [{"code": "33101", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.15, "discounted_cash": 4.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ICE DENTAL TEMPOROMANDIBULAR JOINT DYSFUNCTION", "code_information": [{"code": "DK-22", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 87.3, "discounted_cash": 23.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ICE SOFT KNEE", "code_information": [{"code": "DK-831", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 76.5, "discounted_cash": 20.66, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ICE SOFT SHOULDER DISP", "code_information": [{"code": "DK-841", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 80.73, "discounted_cash": 21.8, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK ICE SOFT UNIVERSAL DISP", "code_information": [{"code": "DK-811", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 54.39, "discounted_cash": 14.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK INSTRUMENT DART-FIRE EDGE 3.0 D1030000", "code_information": [{"code": "D1030000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 502.49, "discounted_cash": 135.67, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LABEL FOR 2.7 MM SCREW ANDINSTR FOR MODULAR GRAPHIC CASE SYS", "code_information": [{"code": "60.116.555", "type": "CDM"}], "standard_charges": [{"gross_charge": 114.71, "discounted_cash": 30.97, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAP BARIARTIC", "code_information": [{"code": "SBA41BABHH", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 474.98, "discounted_cash": 128.24, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAP CUSTOM OCOM", "code_information": [{"code": "DYNJ41112", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 90.29, "discounted_cash": 24.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAPAROSCOPY LAVH STRL", "code_information": [{"code": "DYNJP9120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 122.79, "discounted_cash": 33.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK LAPIPLASTY LESSER TMT FIXATION SK28", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK28", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6150.0, "discounted_cash": 1660.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MINOR CUSTOM OCOM NORTH SBA41MNOCC", "code_information": [{"code": "SBA41MNOCC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 192.58, "discounted_cash": 52.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MINOR OCOM NORTH - SUB 4 SBA41MNOC4", "code_information": [{"code": "SBA41MNOC4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.64, "discounted_cash": 30.68, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MINOR SBA41MNOC5", "code_information": [{"code": "SBA41MNOC5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 113.64, "discounted_cash": 30.68, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MINOR SUB 6 SBA41MNOC6", "code_information": [{"code": "SBA41MNOC6", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.06, "discounted_cash": 31.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK MINOR USPI OCOM NORTH SBA41MNOC3", "code_information": [{"code": "SBA41MNOC3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.16, "discounted_cash": 30.82, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK NOVASURE CO2 CARTRIDGE", "code_information": [{"code": "815012US", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 55.5, "discounted_cash": 14.99, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK OCULOPLASTIC CARDINAL SPP99OC1AA", "code_information": [{"code": "SPP99OC1AA", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.52, "discounted_cash": 20.39, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PLACE EZOUT 70MM 7812-070-001K", "code_information": [{"code": "7812-070-001K", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3287.93, "discounted_cash": 887.74, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK POLY DIST FEMUR MRH GMRS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6481-2-150", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3782.7, "discounted_cash": 1021.33, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PRINT COLOR W/ PRELOADED CARTRIDGE", "code_information": [{"code": "UPC-510C", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 181.57, "discounted_cash": 49.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROC 80IN X 100IN SHOULDER I SHARPS FREE W/ REINFORCED TABLE COVER MAYO STA", "code_information": [{"code": "DYNJP8400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.63, "discounted_cash": 22.04, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROC ORTHO MAJOR W/ REINFORCED TABLE COVER MAYO STAND COVER ECLIPSE POLY RE", "code_information": [{"code": "DYNJP8320", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 19.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE HAT-TRICK BIL", "code_information": [{"code": "72204326", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3287.38, "discounted_cash": 887.59, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE SHOULDER W/ POUCH STRL", "code_information": [{"code": "DYNJP8401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 74.62, "discounted_cash": 20.15, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK PROCEDURE TRANSANAL GELPOINT PATH TA211", "code_information": [{"code": "TA211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3168.75, "discounted_cash": 855.56, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER CDS", "code_information": [{"code": "CDS981748F", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 156.87, "discounted_cash": 42.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER CUSTOM OCOM NORTH SOP41SDOCD", "code_information": [{"code": "SOP41SDOCD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 166.67, "discounted_cash": 45.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER CUSTOM VERSION G PO41SHOKG", "code_information": [{"code": "PO41SHOKG", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 312.73, "discounted_cash": 84.44, "setting": "both", "billing_class": "facility"}]}, {"description": "PACK SHOULDER DBD CDS", "code_information": [{"code": "CDS981748", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATECTOMY", "code_information": [{"code": "48154", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANCREATORRHAPHY", "code_information": [{"code": "48545", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PANNICULECTOMY 15830", "code_information": [{"code": "15830", "type": "CPT"}, {"code": "1481537", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "gross_charge": 4683.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3512.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF HEART SAC", "code_information": [{"code": "33030", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF LARYNX", "code_information": [{"code": "31370", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45111", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RECTUM", "code_information": [{"code": "45114", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF RIB", "code_information": [{"code": "21610", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PARTIAL REMOVAL OF STERNUM", "code_information": 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40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  LOCKING  2.3MM X 22MM TPLS-23220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 294.0, "discounted_cash": 79.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  LOCKING  2.3MM X 23MM TPLS-23230-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23230-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 294.0, "discounted_cash": 79.38, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  LOCKING  2.3MM X 24MM TPLS-23240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 294.0, "discounted_cash": 79.38, "setting": "both", "billing_class": 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LOCKING  2.3MM X 32MM TPLS-23320-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPLS-23320-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 342.0, "discounted_cash": 92.34, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 10MM  TI TPNL-27100-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27100-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 72.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 12MM  TI TPNL-27120-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27120-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 72.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 14MM  TI 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"code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27200-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 72.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 22MM  TI TPNL-27220-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27220-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 72.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 24MM  TI TPNL-27240-TS", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TPNL-27240-TS", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 72.9, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THRD  NON-LOCKING  2.7MM X 26MM  TI TPNL-27260-TS", "code_information": 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604.5, "discounted_cash": 163.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THREADED 3.5MM X 24MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P30-P1-3524", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.5, "discounted_cash": 163.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THREADED 3.5MM X 26MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P30-P1-3526", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 604.5, "discounted_cash": 163.22, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG THREADED 3.5MM X 28MM P30-P1-3528", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P30-P1-3528", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 605.0, "discounted_cash": 163.35, "setting": "both", "billing_class": "facility"}]}, {"description": "PEG TORX SMOOTH 1.8 18MM SPEG1.8-18", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SPEG1.8-18", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 315.0, "discounted_cash": 85.05, "setting": "both", "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION", "code_information": [{"code": "99459", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PELVIC EXAMINATION UNDER ANESTHESIA 57410", "code_information": [{"code": "57410", "type": "CPT"}, {"code": "1481573", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": 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"standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PEN ADHESIVE TISSUE HI VISC 1ML M1261", "code_information": [{"code": "M1261", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 57.11, "discounted_cash": 15.42, "setting": "both", "billing_class": "facility"}]}, {"description": "PEN MULTI-TIP SKIN MARKER WITH RULER 212PR", "code_information": [{"code": "212PR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.17, "discounted_cash": 0.86, "setting": "both", "billing_class": "facility"}]}, {"description": "PEN SURG SIGN N S MARKING MINI", "code_information": [{"code": "1451-1000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL CAUTERY HOLSTER ELECTROSURGICAL LFINSTR DISP", "code_information": [{"code": "E2516H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.99, "discounted_cash": 3.78, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELCTRD .093IN X 10FT CORD BLD HLSTR ROCKER SWITCH W/ ACCUVAC SMOKE EVACUA", "code_information": [{"code": "E2515HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 37.39, "discounted_cash": 10.1, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL 10FT 2.4MM HANDSWITCH LFINSTR DISP", "code_information": [{"code": "E2515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 36.15, "discounted_cash": 9.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL 10FT X .093IN SMOKE EVACUATION W/ 1IN STAINLESS STEEL 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"discounted_cash": 4.3, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL HANDSWITCH PUSH BTN", "code_information": [{"code": "E2516", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.43, "discounted_cash": 3.63, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ELECTROSURGICAL ROCKER HANDSWITCH COATED BLADE DISP", "code_information": [{"code": "E2450H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.22, "discounted_cash": 17.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL HAND ROCKER W/HOLSTER CTD BLA E2350H", "code_information": [{"code": "E2350H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.22, "discounted_cash": 17.07, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCIL ROCKER SWITCH W HOLSTER E2515H", "code_information": [{"code": "E2515H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.72, "discounted_cash": 3.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PENCILTUBINGBOVIE W/SMOKE EVAC E2350HS E2350HS", "code_information": [{"code": "E2350HS", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 53.34, "discounted_cash": 14.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PENILE INJECTION", "code_information": [{"code": "54235", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENILE VENOUS OCCLUSION", "code_information": [{"code": "37790", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54240", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PENIS STUDY", "code_information": [{"code": "54250", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT 65+ YR", "code_information": [{"code": "99397", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PER PM REEVAL EST PAT INFANT", "code_information": [{"code": "99391", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS MR", "code_information": [{"code": "C7502", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC BX BREAST LESIONS STERO", "code_information": [{"code": "C7501", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC CRYO ABLATE RENAL TUM", "code_information": [{"code": "50593", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC D-E COR REVASC CHRO ADD", "code_information": [{"code": "C9608", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 26432.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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"standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERC DRUG-EL COR STENT BRAN", "code_information": [{"code": "C9601", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ ART M-THROMBECT &/NFS", "code_information": [{"code": "61645", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ CVT&LS INJ VERT BODIES", "code_information": [{"code": "C7504", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST MR GUIDE", "code_information": [{"code": "19287", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST 1ST US IMAG", "code_information": [{"code": "19285", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ DEV BREAST ADD MR GUIDE", "code_information": [{"code": "19288", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 ABNOR BI", "code_information": [{"code": "33903", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ P-ART REVSC 1 NM NT UNI", "code_information": [{"code": "33900", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47538", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ PLMT BILE DUCT STENT", "code_information": [{"code": "47540", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ THOR&LUMB VERT AUG", "code_information": [{"code": "C7507", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE EACH", "code_information": [{"code": "93592", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7786.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLOSURE PDA", "code_information": [{"code": "93582", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9837.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee 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CLS AORTIC", "code_information": [{"code": "93591", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 22671.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 22671.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH CLS MITRAL", "code_information": [{"code": "93590", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 22671.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 22671.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRANSCATH SEPTAL REDUXN", "code_information": [{"code": "93583", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TRLUML CORONRY LITHOTRP", "code_information": [{"code": "92972", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ TX NASOETHMOID FX", "code_information": [{"code": "21340", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERQ&IC ALLG TEST DRUGS/BIOL", "code_information": [{"code": "95018", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PERSONA ARTICULAR SURFACE RIGHT 14MM HEIGHT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "42-5221-008-14", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3150.0, "discounted_cash": 850.5, "setting": "both", "billing_class": "facility"}]}, {"description": "PERTUSSIS AG IF", "code_information": [{"code": "87265", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE FULL BODY", "code_information": [{"code": "78813", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1406.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE LTD AREA", "code_information": [{"code": "78811", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1406.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1406.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE SKULL-THIGH", "code_information": [{"code": "78812", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1406.33, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT FULL BODY", "code_information": [{"code": "78816", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1407.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "Service/Procedure/Item is paid as: other.", "standard_charge_dollar": 2908.0, "methodology": "other"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PET IMAGE W/CT SKULL-THIGH", "code_information": [{"code": "78815", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 1407.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": 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"RC"}], "standard_charges": [{"gross_charge": 2697.0, "discounted_cash": 728.19, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENOL 8% 10ML", "code_information": [{"code": "MED0572", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 88.0, "discounted_cash": 23.76, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENOL TOPICAL 89% SWAB", "code_information": [{"code": "MED0785", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 27.27, "discounted_cash": 7.36, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENOL TOPICAL APPLICATION 500 ML", "code_information": [{"code": "MED0633", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.0, "discounted_cash": 2.7, "setting": "both", "billing_class": "facility"}]}, {"description": "PHENOTYPE DNA HIV W/CLT ADD", "code_information": [{"code": "87904", "type": "CPT"}], 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"setting": "both", "billing_class": "facility"}]}, {"description": "PIN 4MM X 110MM BONE  144110", "code_information": [{"code": "144110", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.24, "discounted_cash": 85.92, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 4MM X 140MM BONE  144140", "code_information": [{"code": "144140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 318.24, "discounted_cash": 85.92, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN 70 THR 5X250 APEX S/D HALF 5018-7-250", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5018-7-250", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 334.8, "discounted_cash": 90.4, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN ALIGN BIO MODULAR OFFSET HD", "code_information": [{"code": "11-113940", "type": "CDM"}], "standard_charges": [{"gross_charge": 681.0, "discounted_cash": 183.87, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN APEX 3.0 X 110MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "5038-2-110", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 228.48, "discounted_cash": 61.69, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN AXIS2.5MM X 40MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "US-EAP-25400", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BALL 1.1MM W-SERIES", "code_information": [{"code": "W045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 126.0, "discounted_cash": 34.02, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE 12 MM DISP", "code_information": [{"code": "1007-1200", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 326.4, "discounted_cash": 88.13, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE GUIDE 3.2MM 500373", "code_information": [{"code": "500373", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 172.5, "discounted_cash": 46.58, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN BONE KNEE 78MM LOCKING OSS POLYETHYLENE STERILE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "150478", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 597.0, "discounted_cash": 161.19, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CALCAR INFERIOR EXTRA LONG 5 X 110MM T6-0255-110S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T6-0255-110S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 182.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CALCAR INFERIOR SUPPORT LONG 5X95 T6-0255-095S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "T6-0255-095S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 675.0, "discounted_cash": 182.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN CENTERING 1.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "309.07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.57, "discounted_cash": 89.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COMPRESSION FT SOLID 1.9MM X 30MM AR-9919T-30S", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-9919T-30S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1138.2, "discounted_cash": 307.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COVERS YELLOW", "code_information": [{"code": "101001PBOX", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.63, "discounted_cash": 1.25, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN COVERS YELLOW SMALL", "code_information": [{"code": "13-1001", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.44, "discounted_cash": 1.2, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISPENSING MULTI ACCESS MINI SPIKE LF", "code_information": [{"code": "412012 PIN", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.06, "discounted_cash": 48.62, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DISTRACTION 14MM CASPER SLF DRILLING STRL", "code_information": [{"code": "FF904SB", "type": "CDM"}, {"code": "272", "type": "RC"}], 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"AR-2272", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 479.13, "discounted_cash": 129.37, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL 4MM CLOSED EYELET ACL TIGHTROPE STRL", "code_information": [{"code": "AR-1595TC", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 105.57, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL HEADLESS TROCAR KNEE", "code_information": [{"code": "-5901-020-00", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1009.8, "discounted_cash": 272.65, "setting": "both", "billing_class": "facility"}]}, {"description": "PIN DRILL QUICK RELEASE PATELLOFEMORAL REPLACE SYS VANGUARD STRL", "code_information": [{"code": "32-486265", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 275.4, "discounted_cash": 74.36, "setting": "both", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH THORACIC AORTA", "code_information": [{"code": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH VERTEBRAL ART", "code_information": [{"code": "36226", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATH XTRNL CAROTID", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36215", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36216", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN ARTERY", "code_information": [{"code": "36217", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36010", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE CATHETER IN VEIN", "code_information": [{"code": "36012", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "PLACE DUOD/JEJ TUBE PERC", "code_information": [{"code": "49441", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE ENDORECTAL APP", "code_information": [{"code": "C9725", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43830", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43831", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE", "code_information": [{"code": "43832", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE GASTROSTOMY TUBE PERC", "code_information": [{"code": "49440", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NDL MUSC/TIS FOR RT", "code_information": [{"code": "20555", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLACE NEEDLE IN VEIN", "code_information": [{"code": "36000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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5541.9, "discounted_cash": 1496.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEAU TIBL 12MM SM NPS", "code_information": [{"code": "622164", "type": "CDM"}], "standard_charges": [{"gross_charge": 5541.9, "discounted_cash": 1496.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEAU TIBL 15MM LG NPS", "code_information": [{"code": "622185", "type": "CDM"}], "standard_charges": [{"gross_charge": 5541.9, "discounted_cash": 1496.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEAU TIBL 15MM SM NPS", "code_information": [{"code": "622165", "type": "CDM"}], "standard_charges": [{"gross_charge": 5541.9, "discounted_cash": 1496.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEAU TIBL 20MM LG NPS", "code_information": [{"code": "622186", "type": "CDM"}], "standard_charges": [{"gross_charge": 5541.9, "discounted_cash": 1496.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEAU TIBL 20MM SM NPS", "code_information": [{"code": "622166", "type": "CDM"}], "standard_charges": [{"gross_charge": 5541.9, "discounted_cash": 1496.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEAU TIBL 25MM LG NPS", "code_information": [{"code": "622187", "type": "CDM"}], "standard_charges": [{"gross_charge": 5541.9, "discounted_cash": 1496.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEAU TIBL 25MM SM NPS", "code_information": [{"code": "622167", "type": "CDM"}], "standard_charges": [{"gross_charge": 5541.9, "discounted_cash": 1496.31, "setting": "both", "billing_class": "facility"}]}, {"description": "PLATEFIBULA VARIAX 8H 137MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "40-20908", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1854.72, "discounted_cash": 500.77, "setting": "both", "billing_class": "facility"}]}, {"description": 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT BILIARY DRAINAGE CATH", "code_information": [{"code": "47533", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROSTOMY CATHETER", "code_information": [{"code": "50432", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT NEPHROURETERAL CATHETER", "code_information": [{"code": "50433", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT ADDL", "code_information": [{"code": "222T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT LUMB", "code_information": [{"code": "221T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT POST FACET IMPLT THOR", "code_information": [{"code": "220T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee 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"UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV 1ST", "code_information": [{"code": "10035", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT SFT TISS LOCLZJ DEV EA", "code_information": [{"code": "10036", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50693", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT URETERAL STENT PRQ", "code_information": [{"code": "50695", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLMT XTN PROSTH EVASC RPR", "code_information": [{"code": "34709", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PLNNING PT SPEC FENEST GRAFT", "code_information": [{"code": "34839", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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5400.0, "discounted_cash": 1458.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PRE-KLENZ INSTRUMENT SPRAY.22 OZ 150377", "code_information": [{"code": "150377", "type": "CDM"}], "standard_charges": [{"gross_charge": 5439.0, "discounted_cash": 1468.53, "setting": "both", "billing_class": "facility"}]}, {"description": "PREGNANCY TEST URINE DIPSTICK", "code_information": [{"code": "4582105026", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "PREMARIN VAGINAL CREAM 0.625 MG/G 30G (NO CHARGE)", "code_information": [{"code": "MED0233", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 739.01, "discounted_cash": 199.53, "setting": "both", "billing_class": "facility"}]}, {"description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [{"code": "791", "type": "MS-DRG"}], "standard_charges": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP CHLORAPREP 26ML ORANGE STERILE 930815", "code_information": [{"code": "930815", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 31.64, "discounted_cash": 8.54, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP CORNEAL ENDO ALLOGRAFT", "code_information": [{"code": "65757", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR INTESTINE/VENOUS", "code_information": [{"code": "44720", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER 3-SEGMENT", "code_information": [{"code": "47144", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER LOBE SPLIT", "code_information": [{"code": "47145", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/ARTERIAL", "code_information": [{"code": "47147", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR LIVER/VENOUS", "code_information": [{"code": "47146", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR PANCREAS", "code_information": [{"code": "48551", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP DONOR RENAL GRAFT", "code_information": [{"code": "50325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREP KIT DYNAFORCE STAPLE 18MM 7100-1800", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7100-1800", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "PREP RENAL GRAFT/ARTERIAL", "code_information": [{"code": "50328", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21079", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PREPARE FACE/ORAL PROSTHESIS", "code_information": [{"code": "21082", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 18771.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARD STENT/ATH/ANGIO", "code_information": [{"code": "92934", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 18771.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 18771.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIO ADDL ART", "code_information": [{"code": "92921", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13479.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 13479.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ CARDIAC ANGIOPLAST 1 ART", "code_information": [{"code": "92920", 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ ELC NRV STIM CN WO IMPLT", "code_information": [{"code": "720T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 18771.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "PRQ REVASC BYP GRAFT ADDL", "code_information": [{"code": "92938", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 18771.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "R HRT CORONARY ARTERY ANGIO", "code_information": [{"code": "93456", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HEAT TREATED", "code_information": [{"code": "90376", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG HT&SOL HUMAN IM/SC", "code_information": [{"code": "90377", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES IG IM/SC", "code_information": [{"code": "90375", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE ID", "code_information": [{"code": "90676", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RABIES VACCINE IM", "code_information": [{"code": "90675", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RACK SCREW 2.7MM FOR MODULAR GRAPHIC CASE SYS FOR MOULE SHELL", "code_information": [{"code": "60.116.072", "type": "CDM"}], "standard_charges": [{"gross_charge": 658.35, "discounted_cash": 177.75, "setting": "both", "billing_class": "facility"}]}, {"description": "RACK SCREW FOR 6.5 MM CANNULATED SCREW 16 MM AND 32 MM THREAD LEN", "code_information": [{"code": "690.375.70", "type": "CDM"}], "standard_charges": [{"gross_charge": 1370.0, "discounted_cash": 369.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RACK SCREW FOR 7.3 MM CANNULATED SCREW 16 MM AND 32 MM THREAD LEN", "code_information": [{"code": "690.375.50", "type": "CDM"}], "standard_charges": [{"gross_charge": 1370.0, "discounted_cash": 369.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RAD EXC LESION UP TO 1.25 CM", "code_information": [{"code": "D7410", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM DSTL/SHFT HUM", "code_information": [{"code": "24150", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESCJ TUM TISS A/E 5 CM+", "code_information": [{"code": "24079", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESECT ABD TUMOR 5 CM/>", "code_information": [{"code": "22905", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RAD RESECT HAND TUMOR 3 CM/>", "code_information": [{"code": "26118", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL KERATOTOMY", "code_information": [{"code": "65771", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIAL OSTEOTOME BLADE 10MM", "code_information": [{"code": "430062", "type": "CDM"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 144.18, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIAL OSTEOTOME BLADE 6MM", "code_information": [{"code": "430060", "type": "CDM"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 144.18, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIAL OSTEOTOME BLADE 8MM", "code_information": [{"code": "430061", "type": "CDM"}], "standard_charges": [{"gross_charge": 534.0, "discounted_cash": 144.18, "setting": "both", "billing_class": "facility"}]}, {"description": "RADIAL STYLOIDECTOMY 25230", "code_information": [{"code": "25230", "type": "CPT"}, {"code": "1481666", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "gross_charge": 4437.0, "discounted_cash": 1197.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION HANDLING", "code_information": [{"code": "77790", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 54.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77336", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 82.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION PHYSICS CONSULT", "code_information": [{"code": "77370", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 170.69, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY DOSE PLAN", "code_information": [{"code": "77300", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 57.08, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY MANAGEMENT", "code_information": [{"code": "77431", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 158.14, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77261", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 116.2, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77262", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 175.63, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION THERAPY PLANNING", "code_information": [{"code": "77263", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 260.93, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77332", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 74.31, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77333", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 30.95, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT AID(S)", "code_information": [{"code": "77334", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 136.02, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77401", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 39.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77402", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 208.85, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77407", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 339.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TREATMENT DELIVERY", "code_information": [{"code": "77412", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 322.82, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RADIATION TX MANAGEMENT X5", "code_information": [{"code": "77427", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 312.39, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35304", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHANNELING OF ARTERY", "code_information": [{"code": "35341", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECHARGER BELT LARGE FP9000L", "code_information": [{"code": "FP9000L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.25, "discounted_cash": 23.29, "setting": "both", "billing_class": "facility"}]}, {"description": "RECIPROCATING BLADE HEAVY DUTY 52.6  X  0.64MM", "code_information": [{"code": "277-096-250S5", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 85.25, "discounted_cash": 23.02, "setting": "both", "billing_class": "facility"}]}, {"description": "RECLAIM DISTAL TAPERED 16X190A", "code_information": [{"code": "197716190", "type": "CDM"}], "standard_charges": [{"gross_charge": 9593.1, "discounted_cash": 2590.14, "setting": "both", "billing_class": "facility"}]}, {"description": "RECLAIM DISTAL TAPERED 18X140", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": 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"maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW SEGMENT", "code_information": [{"code": "21198", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTR LWR JAW W/ADVANCE", "code_information": [{"code": "21199", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ELBOW JOINT", "code_information": [{"code": "24361", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 16586.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 15150.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 16586.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21179", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT ENTIRE FOREHEAD", "code_information": [{"code": "21180", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT INJURED CHEST", "code_information": [{"code": "32820", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LARYNX & PHARYNX", "code_information": [{"code": "31395", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LIP WITH FLAP", "code_information": [{"code": "40525", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT LOWER JAW BONE", "code_information": [{"code": "21247", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCT URETHRA/BLADDER", "code_information": [{"code": "53431", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RECONSTRUCTION OF LOWER JAW", "code_information": [{"code": "21244", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, 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[{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCT SIMPLE FACIAL BONE FX", "code_information": [{"code": "D7680", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REDUCTION MAMMOPLASTY 19318", "code_information": [{"code": "19318", "type": "CPT"}, {"code": "1481737", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 7911.0, "gross_charge": 10548.0, "discounted_cash": 2847.96, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REEXPLORATION PELVIC WOUND", "code_information": [{"code": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REGN CELL TX SCLDR HANDS", "code_information": [{"code": "489T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REHABILITATION WITH CC/MCC", "code_information": [{"code": "945", "type": "MS-DRG"}], "standard_charges": [{"minimum": 825.0, "maximum": 1992.0, "setting": "inpatient", "payers_information": [{"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS BLUE ADVANTAGE", "standard_charge_dollar": 1992.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS OF OK TRADITIONAL", "standard_charge_dollar": 1992.0, "methodology": "per diem"}, {"payer_name": "BLUE CROSS/BLUE SHIELD", "plan_name": "BCBS PREFERRED/OPTIONS", "standard_charge_dollar": 1992.0, "methodology": "per diem"}, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50780", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50782", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50783", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANT URETER IN BLADDER", "code_information": [{"code": "50785", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REIMPLANTATION OF KIDNEY", "code_information": [{"code": "50380", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE CLAVICLE", "code_information": [{"code": "23490", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE EYE WALL", "code_information": [{"code": "67250", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REINFORCE RADIUS", "code_information": [{"code": "25490", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE INNER EAR CANAL", "code_information": [{"code": "69960", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE INTRINSIC MUSCLES HAND-EACH MUSCLE 26593", "code_information": [{"code": "26593", "type": "CPT"}, {"code": "1481749", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "gross_charge": 4567.0, "discounted_cash": 1233.09, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3425.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE MIDDLE EAR BONE", "code_information": [{"code": "69650", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF EYE FLUID", "code_information": [{"code": "67015", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF LUNG", "code_information": [{"code": "32220", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF MIDFOOT JOINT", "code_information": [{"code": "28264", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELEASE OF SHOULDER LIGAMENT", "code_information": [{"code": "23415", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELIEVE CRANIAL PRESSURE", "code_information": [{"code": "61345", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOAD ECHELON GRY 60MM STERILE 6RW STPL ECR60M", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ECR60M", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 379.23, "discounted_cash": 102.39, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD GST BLUE 60MM 6ROW GST60B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD GST GREEN 60MM 6ROW GST60G", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "GST60G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD HERNIA 4 MM BLACK MULTIFIRE ENDO", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 302.58, "discounted_cash": 81.7, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD LINEAR CUTTER -ORDR QTY 12 6R45B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "6R45B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 290.49, "discounted_cash": 78.43, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD LINEAR CUTTER 75MM GREEN TRT75", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "TRT75", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 203.14, "discounted_cash": 54.85, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD MULTIFIRE ENDO HERNIA 4.8 BLK 174007", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "174007", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 302.58, "discounted_cash": 81.7, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER 2.5 MM RED GIA 60", "code_information": [{"code": "GIA6025S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 614.51, "discounted_cash": 165.92, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER 2.5MM TO 3MM STAPLE VASCULAR PROXIMATE TI", "code_information": [{"code": "ESTRV30", "type": "CDM"}], "standard_charges": [{"gross_charge": 118.36, "discounted_cash": 31.96, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STAPLER LINEAR TITANIUM 60MM BLUE XR60B", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "XR60B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 111.6, "discounted_cash": 30.13, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STPLR 45MM GRN REG LINEAR CUTTER ENDO THKTIS PISTOL GRIP ENDOPATH LF STRL", "code_information": [{"code": "TR45G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 340.28, "discounted_cash": 91.88, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD STPLR 55MM BLUE LINEAR CUTTER SAFETY LOCKOUT PROXIMATE LF TI STRL", "code_information": [{"code": "TCR55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 136.15, "discounted_cash": 36.76, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOAD TRI 2.0 SUL 60 ART XTRA THK SIG60AXT", "code_information": [{"code": "C1889", "type": "HCPCS"}, {"code": "SIG60AXT", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1930.04, "discounted_cash": 521.11, "setting": "both", "billing_class": "facility"}]}, {"description": "RELOC SKIN POCKET PLS GEN", "code_information": [{"code": "416T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATE POCKET FOR DEFIB", "code_information": [{"code": "33223", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATION OF TESTIS(ES)", "code_information": [{"code": "54680", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RELOCATION POCKET PACEMAKER", "code_information": [{"code": "33222", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEV W/O FLAP", "code_information": [{"code": "D7300", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ANCHORAGE DEVICE W/FLAP", "code_information": [{"code": "D7299", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REM ENDOVAS VENA CAVA FILTER", "code_information": [{"code": "37193", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER LESION", "code_information": [{"code": "51530", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BLADDER STONE", "code_information": [{"code": "51050", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61518", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF BRAIN LESION", "code_information": [{"code": "61520", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 8811.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF DONOR HEART", "code_information": [{"code": "33940", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF EYE", "code_information": [{"code": "65110", "type": "CPT"}], "standard_charges": 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20920", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FASCIA FOR GRAFT", "code_information": [{"code": "20922", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF FRONTAL SINUS", "code_information": [{"code": "31086", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF GUM TISSUE", "code_information": [{"code": "41830", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HEART LESION", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF HIP PROSTHESIS", "code_information": [{"code": "27090", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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[{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": "31300", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LARYNX LESION", "code_information": [{"code": 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEFT HEART VENT", "code_information": [{"code": "33989", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF LEG VEINS/LESION", "code_information": [{"code": "37735", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 4119.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NERVE LESION", "code_information": [{"code": "64792", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF NOSE POLYP(S)", "code_information": [{"code": "30110", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OCULAR IMPLANT", "code_information": [{"code": "65175", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF OVARY(S)", "code_information": [{"code": "58943", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PACEMAKER SYSTEM", "code_information": [{"code": "33234", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREAS LESION", "code_information": [{"code": "48120", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PANCREATIC DUCT", "code_information": [{"code": "48148", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PELVIC STRUCTURES", "code_information": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"code_information": [{"code": "54125", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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{"description": "REMOVAL OF PITUITARY GLAND", "code_information": [{"code": "61548", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PM GENERATOR", "code_information": [{"code": "33233", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF PREVIOUSLY IMPLANTED INTRATEHCAL OR EPIDURAL CATHETER 62355", "code_information": [{"code": "62355", "type": "CPT"}, {"code": "1863137", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 6173.0, "discounted_cash": 1666.71, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB", "code_information": [{"code": "21615", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"description": "REMOVAL OF RIB AND NERVES", "code_information": [{"code": "21616", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF RIB(S)", "code_information": [{"code": "32900", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH", "code_information": [{"code": "43622", "type": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43631", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43633", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF STOMACH PARTIAL", "code_information": [{"code": "43635", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 5997.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6707.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TAIL BONE ULCER", "code_information": [{"code": "15920", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR GLAND", 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total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TEAR SAC", "code_information": [{"code": "68520", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TESTIS", "code_information": [{"code": "54530", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYMUS GLAND", "code_information": [{"code": "60522", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF THYROID", "code_information": [{"code": "60252", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF TONSILS", "code_information": [{"code": "42826", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVAL OF URETER STONE", "code_information": [{"code": "51060", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee 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"billing_class": "facility"}]}, {"description": "REMOVALINSTRATION TAPER ADAPTOR HEAD SEPERATOR RAMP BIO-MOORE II", "code_information": [{"code": "31-482558", "type": "CDM"}], "standard_charges": [{"gross_charge": 2190.0, "discounted_cash": 591.3, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVE & TREAT BRAIN LESION", "code_information": [{"code": "61544", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ABDOMEN LYMPH NODES", "code_information": [{"code": "38780", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE AORTIC ASSIST DEVICE", "code_information": [{"code": "33968", "type": "CPT"}], 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1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER STONE", "code_information": [{"code": "52318", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51590", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51595", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN CAVITY FLUID", "code_information": [{"code": "61020", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN ELECTRODES", "code_information": [{"code": "61535", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61512", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN LINING LESION", "code_information": [{"code": "61519", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE BRAIN TUMOR W/SCOPE", "code_information": [{"code": "62164", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60605", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX REPAIR BOWEL", "code_information": [{"code": "57556", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR PELVIS", "code_information": [{"code": "57545", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERVIX/REPAIR VAGINA", "code_information": [{"code": "57555", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLAR BONE LESION", "code_information": [{"code": "23170", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE COLLOID CYST W/SCOPE", "code_information": [{"code": "62162", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CORONOID PROCESS", "code_information": [{"code": "21070", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CRANIAL CAVITY FLUID", "code_information": [{"code": "61001", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA DEVICE OBSTRUCT", "code_information": [{"code": "75901", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 191.07, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CVA LUMEN OBSTRUCT", "code_information": [{"code": "75902", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 80.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE DRUG IMPLANT", "code_information": [{"code": "G0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69140", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR CANAL LESION(S)", "code_information": [{"code": "69145", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EAR LESION", "code_information": [{"code": "69540", "type": "CPT"}], "standard_charges": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELCTRD TRANSVENOUSLY", "code_information": [{"code": "33244", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33236", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33237", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELECTRODE/THORACOTOMY", "code_information": [{"code": "33238", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ELTRD/THORACOTOMY", "code_information": [{"code": "33243", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE ESOPHAGUS OBSTRUCTION", "code_information": [{"code": "74235", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 99.74, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EXOSTOSIS MANDIBLE", "code_information": [{"code": "21031", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/INSERT IMPLANT", "code_information": [{"code": "65103", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYE/REVISE SOCKET", "code_information": [{"code": "65112", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE EYELID LINING LESION", "code_information": [{"code": "68115", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FINGER BONE", "code_information": [{"code": "26185", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY ADBOMEN", "code_information": [{"code": "49402", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY BRAIN", "code_information": [{"code": "61570", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65205", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65210", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE FOREIGN BODY FROM EYE", "code_information": [{"code": "65220", "type": "CPT"}], 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE GASTRIC PORT OPEN", "code_information": [{"code": "43887", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 15797.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 15797.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15941", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15945", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE HIP PRESSURE SORE", "code_information": [{"code": "15946", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPACTED EAR WAX UNI", "code_information": [{"code": "69210", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE IMPLANT BODY", "code_information": [{"code": "D6105", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INFECTED SKULL BONE", "code_information": [{"code": "61501", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR", "code_information": [{"code": "69905", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR & MASTOID", "code_information": [{"code": "69910", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"billing_class": "facility"}]}, {"description": "REMOVE INTERIM IMPLANT", "code_information": [{"code": "D6198", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUMB ARTIF DISC ADDL", "code_information": [{"code": "164T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33910", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG ARTERY EMBOLI", "code_information": [{"code": "33915", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG CATHETER", "code_information": [{"code": "32552", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG FOREIGN BODY", "code_information": [{"code": "32151", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LUNG PNEUMONECTOMY", "code_information": [{"code": "32440", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MANDIBLE CYST COMPLEX", "code_information": [{"code": "21046", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID AIR CELLS", "code_information": [{"code": "69670", "type": "CPT"}], "standard_charges": 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"UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MASTOID STRUCTURES", "code_information": [{"code": "69505", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MAXILLA CYST COMPLEX", "code_information": [{"code": "21048", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE MUTI-COMP PENIS PROS", "code_information": [{"code": "54406", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30300", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NASAL FOREIGN BODY", "code_information": [{"code": "30320", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE NON-RESORB BARRIER", "code_information": [{"code": "D4286", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PALATE/LESION", "code_information": [{"code": "42120", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART LUMBAR VERTEBRA", "code_information": [{"code": "22114", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22100", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF NECK VERTEBRA", "code_information": [{"code": "22110", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART OF TEMPORAL BONE", "code_information": [{"code": "69535", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PART THORAX VERTEBRA", "code_information": [{"code": "22101", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PELVIS LYMPH NODES", "code_information": [{"code": "38770", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54130", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PENIS & NODES", "code_information": [{"code": "54135", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PHARYNX FOREIGN BODY", "code_information": [{"code": "42809", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PITUIT TUMOR W/SCOPE", "code_information": [{"code": "62165", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PROSTATE REGROWTH", "code_information": [{"code": "52630", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PULMONARY SHUNT", "code_information": [{"code": "33924", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PULSE GENERATOR", "code_information": [{"code": "33241", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTAL OBSTRUCTION", "code_information": [{"code": "45915", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RECTUM W/RESERVOIR", "code_information": [{"code": "45119", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE RENAL TUBE W/FLUORO", "code_information": [{"code": "50389", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15936", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SACRUM PRESSURE SORE", "code_information": [{"code": "15937", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SCIATIC NERVE LESION", "code_information": [{"code": "64786", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SELF-CONTD PENIS PROS", "code_information": [{"code": "54415", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER BLADE LESION", "code_information": [{"code": "23172", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SHOULDER FB DEEP", "code_information": [{"code": "23333", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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POUCH", "code_information": [{"code": "55650", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM POUCH LESION", "code_information": [{"code": "55680", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINAL CORD LESION", "code_information": [{"code": "63600", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6553.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPINE LAMINA 1/2 CRVL", "code_information": [{"code": "63001", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THORACIC LYMPH NODES", "code_information": [{"code": "38746", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE THYROID LESION", "code_information": [{"code": "60200", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TONSILS AND ADENOIDS", "code_information": [{"code": "42821", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE TRANSPLANTED KIDNEY", "code_information": [{"code": "50370", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE URETER STENT PERCUT", "code_information": [{"code": "50384", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE UTERUS AFTER CESAREAN", "code_information": [{"code": "59525", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE COMPL", "code_information": [{"code": "57111", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA TISSUE PART", "code_information": [{"code": "57107", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL COMPLETE", "code_information": [{"code": "57110", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VAGINA WALL PARTIAL", "code_information": [{"code": "57106", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION SCOPE/GRAFT", "code_information": [{"code": "31546", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VC LESION W/SCOPE", "code_information": [{"code": "31545", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTILATING TUBE", "code_information": [{"code": "69424", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VENTRICULAR DEVICE", "code_information": [{"code": "33977", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT BODY DCMPRN LMBR", "code_information": [{"code": "63102", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT IDRL BODY CRVCL", "code_information": [{"code": "63304", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERT XDRL BODY THRC", "code_information": [{"code": "63301", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63082", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63086", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63088", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE VERTEBRAL BODY ADD-ON", "code_information": [{"code": "63091", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31785", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE WINDPIPE LESION", "code_information": [{"code": "31786", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE&REPLACE PM GEN SINGL", "code_information": [{"code": "33227", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 28862.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 28862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/GRAFT FOREARM LESION", "code_information": [{"code": "25125", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"description": "REMOVE/GRAFT HIP BONE LESION", "code_information": [{"code": "27067", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE/REPLACE PENIS PROSTH", "code_information": [{"code": "54410", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9837.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVER STAPLE SKIN DYNJ04058A", "code_information": [{"code": "DYNJ04058A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.5, "discounted_cash": 0.95, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVER STAPLE STERILE DISPOSABLE SKIN 16-1028", "code_information": [{"code": "16-1028", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.19, "discounted_cash": 1.13, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVER TRAY MODULAR TIBL VANGUARD", "code_information": [{"code": "32-484062", "type": "CDM"}], "standard_charges": [{"gross_charge": 6540.0, "discounted_cash": 1765.8, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVER TRIAL FEMORAL OXFORD", "code_information": [{"code": "US32-420126", "type": "CDM"}], "standard_charges": [{"gross_charge": 4416.0, "discounted_cash": 1192.32, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVERINPLANT FEMORAL TIBIAL", "code_information": [{"code": "32-467299", "type": "CDM"}], "standard_charges": [{"gross_charge": 6906.0, "discounted_cash": 1864.62, "setting": "both", "billing_class": "facility"}]}, {"description": "REMOVERINSTR AGC", "code_information": [{"code": "32-467296", "type": "CDM"}], "standard_charges": [{"gross_charge": 5067.0, "discounted_cash": 1368.09, "setting": "both", "billing_class": "facility"}]}, {"description": "REMV&REPLC PM GEN DUAL LEAD", "code_information": [{"code": "33228", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 28862.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"discounted_cash": 13.28, "setting": "both", "billing_class": "facility"}]}, {"description": "REP GARMENT CALF VENAFLOW POS LOCK UP TO 19IN", "code_information": [{"code": "3010-PLR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 51.45, "discounted_cash": 13.89, "setting": "both", "billing_class": "facility"}]}, {"description": "REP GARMENT FOOT VENAFLOW POS LOCK UP TO 16IN", "code_information": [{"code": "3016-PLR", "type": "CDM"}], "standard_charges": [{"gross_charge": 64.49, "discounted_cash": 17.41, "setting": "both", "billing_class": "facility"}]}, {"description": "REP GRASPER LAP 36.0 C 10.0MM BBCCK RATCHET HANDLE ENDOPATH", "code_information": [{"code": "10BBR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 84.56, "discounted_cash": 22.83, "setting": "both", "billing_class": "facility"}]}, {"description": "REP HOOK ELECTRODE 8.5ININSULATED ARTHROSCOPIC SS", "code_information": [{"code": "E1510R", 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{"description": "REP KNIFE RETROGRADE LIGAMENT DISP", "code_information": [{"code": "200-1003R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 521.4, "discounted_cash": 140.78, "setting": "both", "billing_class": "facility"}]}, {"description": "REP KNIFE SAFEGUARD MINI", "code_information": [{"code": "8-0003R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.34, "discounted_cash": 50.58, "setting": "both", "billing_class": "facility"}]}, {"description": "REP MASK SURG PARTICULATE RESPIRATOR HYPOALLERGENIC TYPE N95 NIOSH APPROVED MOLDED F", "code_information": [{"code": "1860R", "type": "CDM"}], "standard_charges": [{"gross_charge": 25.59, "discounted_cash": 6.91, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NDL DISSECTION 45 DEG 3/32IN MICRO COLORADO SLV", "code_information": [{"code": "N117R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.11, "discounted_cash": 19.47, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJ SUREFIRE FOR USEIN ARTHROSCOPIC AND MINI OPEN PROCEDURES SCORPIONINSTR", "code_information": [{"code": "AR-13991NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.82, "discounted_cash": 64.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJECTION HUMPBACK MULTIFIRE SCORPIONINSTR DISP", "code_information": [{"code": "AR-13995NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 262.04, "discounted_cash": 70.75, "setting": "both", "billing_class": "facility"}]}, {"description": "REP NEEDLE INJECTION SHOULDER SCORPION STRLINSTR", "code_information": [{"code": "AR-13990NR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 202.2, "discounted_cash": 54.59, "setting": "both", "billing_class": "facility"}]}, {"description": "REP 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{"description": "REP RETRIEVER SUTURE HOFFEE BLUE LASSO", "code_information": [{"code": "22701R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 80.76, "discounted_cash": 21.81, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE 5.5 X 25.0MM OSCILLATING SML", "code_information": [{"code": "2296-33-414R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.11, "discounted_cash": 21.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE 9MM X 25MM X .38MM OSCILLATING", "code_information": [{"code": "2296-3-511R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.56, "discounted_cash": 14.19, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE AGGRESSIVE OSCILLATING SML", "code_information": [{"code": "SP-111AR", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.61, "discounted_cash": 22.57, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE BUSA 60 X 35MM DUAL CUT", "code_information": [{"code": "2108-107-4S1R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 131.69, "discounted_cash": 35.56, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE BUSA 85 X 25M SAGITTAL", "code_information": [{"code": "2108-151R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 79.11, "discounted_cash": 21.36, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BLADE SAGITTAL 9 X 25MM OSCILLATING", "code_information": [{"code": "KM3-111R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.85, "discounted_cash": 23.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REP SAW BONE OSCILLATING 25 X 90 X 1.19MM STAND WIDE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE ARM", "code_information": [{"code": "35013", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE BELLY", "code_information": [{"code": "35122", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE CHEST", "code_information": [{"code": "35022", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE GROIN", "code_information": [{"code": "35132", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE NECK", "code_information": [{"code": "35002", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE SPLEEN", "code_information": [{"code": "35112", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY RUPTURE THIGH", "code_information": [{"code": "35142", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ARTERY TRANSLOCATION", "code_information": [{"code": "33506", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER NECK", "code_information": [{"code": "51845", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLADDER/VAGINA LESION", "code_information": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35189", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35216", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD VESSEL LESION", "code_information": [{"code": "35266", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 4553.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BLOOD 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-BLADDER FISTULA", "code_information": [{"code": "44661", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, 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"standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BOWEL-SKIN FISTULA", "code_information": [{"code": "44640", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BRAIN FLUID LEAKAGE", "code_information": [{"code": "62100", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR BRONCHUS ADD-ON", "code_information": [{"code": "32501", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR DEFECT OF ARTERY", "code_information": [{"code": "35111", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EARDRUM STRUCTURES", "code_information": [{"code": "69635", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR ESOPHAGUS OPENING", "code_information": [{"code": "43420", "type": "CPT"}], "standard_charges": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 8011.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR EYELID DEFECT", "code_information": [{"code": "67902", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6454.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR GUM", 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HAND DEFORMITY", "code_information": [{"code": "26580", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33681", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33684", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR HEART SEPTUM DEFECT", "code_information": [{"code": "33688", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MAXILLOFACIAL DEFECTS", "code_information": [{"code": "D7955", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW W/ LOCAL TISSUE 24345", "code_information": [{"code": "24345", "type": "CPT"}, {"code": "1481707", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6430.5, "gross_charge": 8574.0, "discounted_cash": 2314.98, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6430.5, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MODIFIED FONTAN", "code_information": [{"code": "33615", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR MOUTH LACERATION", "code_information": [{"code": "40830", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 4662.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF ABDOMINAL WALL", "code_information": [{"code": "49900", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART CHAMBERS", "code_information": [{"code": "33670", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECT", "code_information": [{"code": "33720", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF HEART DEFECTS", "code_information": [{"code": "33660", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF LOWER LEG", "code_information": [{"code": "27727", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33425", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33426", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF MITRAL VALVE", "code_information": [{"code": "33427", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF NONUNION OF CARPAL BONE/ EACH EXCLUDING SCAPHOID 25431", "code_information": [{"code": "25431", "type": "CPT"}, {"code": "1481957", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "gross_charge": 6660.0, "discounted_cash": 1798.2, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SKULL & BRAIN", "code_information": [{"code": "62145", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPERM DUCT", "code_information": [{"code": "55400", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63700", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63702", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63704", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF SPINAL HERNIATION", "code_information": [{"code": "63706", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STERNUM SEPARATION", "code_information": [{"code": "21750", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF STOMACH LESION", "code_information": [{"code": "43840", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA DEFECT", "code_information": [{"code": 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF URETHRA INJURY", "code_information": [{"code": "53515", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR OF WINDPIPE INJURY", "code_information": [{"code": "31805", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR PULMONARY ATRESIA", "code_information": [{"code": "33920", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR QUADRICEPS 27430", "code_information": [{"code": "27430", "type": "CPT"}, {"code": "1481980", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "gross_charge": 8395.0, "discounted_cash": 2266.65, "setting": "both", "payers_information": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6296.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM-VAGINA FISTULA", "code_information": [{"code": "57305", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR RECTUM/REMOVE SIGMOID", "code_information": [{"code": "45550", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SALIVARY DUCT", "code_information": [{"code": "42505", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SEPTAL DEFECT", 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33617", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SINGLE VENTRICLE", "code_information": [{"code": "33619", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SKULL CAVITY LESION", "code_information": [{"code": "62120", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR SLEEP APNEA APPLIANCE", "code_information": [{"code": "D9949", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STERN/NUSS W/O SCOPE", "code_information": [{"code": "21742", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPAIR STERNUM/NUSS W/SCOPE", 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE BRAIN CAVITY SHUNT", "code_information": [{"code": "62258", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": 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HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 5970.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE CVAD CATH", "code_information": [{"code": "36580", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE ELBOW JOINT", "code_information": [{"code": "24363", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 16586.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 15150.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 16586.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE EYE FLUID", "code_information": [{"code": "67025", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE MATERIAL PROSTHESIS", "code_information": [{"code": "D6197", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE TUNNELED CV DEVICE W/PUMP 36583", "code_information": [{"code": "36583", "type": "CPT"}, {"code": "46175316", "type": "CDM"}, {"code": "360", "type": "RC"}], 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE URETER BY BOWEL", "code_information": [{"code": "50840", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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"standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACE VAD INTRA W/O BP", "code_information": [{"code": "33982", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6147.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPLACEMENT PULMONARY VALVE", "code_information": [{"code": "33475", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION PACING-DEFIB LEAD", "code_information": [{"code": "33215", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REPOSITION VENOUS CATHETER", "code_information": [{"code": "36597", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee 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INCISION 66825", "code_information": [{"code": "66825", "type": "CPT"}, {"code": "1482012", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "gross_charge": 5296.0, "discounted_cash": 1429.92, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM COMPLEX", "code_information": [{"code": "39561", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT DIAPHRAGM SIMPLE", "code_information": [{"code": "39560", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOOT/TOE TUMOR < 3 CM", "code_information": [{"code": "28046", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FORARM/WRIST TUM 3CM>", "code_information": [{"code": "25078", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT FOREARM/WRIST TUM<3CM", "code_information": [{"code": "25077", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HEART SAC LESION", "code_information": [{"code": "33050", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP TUM INCL ACETABUL", "code_information": [{"code": "27076", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM 5 CM/>", "code_information": [{"code": "27059", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT HIP/PELV TUM < 5 CM", "code_information": [{"code": "27049", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT MEDIASTINAL TUMOR", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NASOPHARYNX SKULL", 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NECK THORAX TUMOR<5CM", "code_information": [{"code": "21557", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT NECK TUMOR 5 CM/>", "code_information": [{"code": "21558", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT OVARIAN MALIGNANCY", "code_information": [{"code": "58951", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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"standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PHALANX OF TOE TUMOR", "code_information": [{"code": "28175", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT PROX FINGER TUMOR", "code_information": [{"code": "26260", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RECUR GYN MAL W/LYM", "code_information": [{"code": "58958", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT RECURRENT GYN MAL", "code_information": [{"code": "58957", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT SHOULDER TUMOR < 5 CM", "code_information": [{"code": "23077", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TALUS/CALCANEUS TUM", "code_information": [{"code": "27647", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TARSAL TUMOR", "code_information": [{"code": "28171", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT THIGH/KNEE TUM 5 CM/>", "code_information": [{"code": "27364", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RESECT TIBIA TUMOR", "code_information": [{"code": "27645", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"discounted_cash": 4726.51, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA 205MM BOWED STM 8X14MM RT", "code_information": [{"code": "6015-0814R", "type": "CDM"}], "standard_charges": [{"gross_charge": 17505.6, "discounted_cash": 4726.51, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA 205MM BOWED STM 9X15MM LT", "code_information": [{"code": "6015-0915L", "type": "CDM"}], "standard_charges": [{"gross_charge": 17505.6, "discounted_cash": 4726.51, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA 205MM BOWED STM 9X15MM RT", "code_information": [{"code": "6015-0915R", "type": "CDM"}], "standard_charges": [{"gross_charge": 17505.6, "discounted_cash": 4726.51, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA 205MM STRT STM 10X14MM", "code_information": [{"code": "6013-1014", "type": "CDM"}], "standard_charges": [{"gross_charge": 16585.8, "discounted_cash": 4478.17, "setting": 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[{"code": "6013-1420", "type": "CDM"}], "standard_charges": [{"gross_charge": 16585.8, "discounted_cash": 4478.17, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA 205MM STRT STM 8X12MM", "code_information": [{"code": "6013-0812", "type": "CDM"}], "standard_charges": [{"gross_charge": 16585.8, "discounted_cash": 4478.17, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA 205MM STRT STM 8X14MM", "code_information": [{"code": "6013-0814", "type": "CDM"}], "standard_charges": [{"gross_charge": 16585.8, "discounted_cash": 4478.17, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA 205MM STRT STM 9X13MM", "code_information": [{"code": "6013-0913", "type": "CDM"}], "standard_charges": [{"gross_charge": 16585.8, "discounted_cash": 4478.17, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA 205MM STRT STM 9X15MM", "code_information": [{"code": "6013-0915", "type": "CDM"}], "standard_charges": [{"gross_charge": 16585.8, "discounted_cash": 4478.17, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED LT STM 10X14MM", "code_information": [{"code": "6014-1014L", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED LT STM 11X15MM", "code_information": [{"code": "6014-1115L", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED LT STM 12X16MM", "code_information": [{"code": "6014-1216L", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED LT STM 13X17MM", "code_information": [{"code": "6014-1317L", "type": "CDM"}], "standard_charges": 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[{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED RT STM 11X15MM", "code_information": [{"code": "6014-1115R", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED RT STM 12X16MM", "code_information": [{"code": "6014-1216R", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED RT STM 13X17MM", "code_information": [{"code": "6014-1317R", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED RT STM 14X18MM", "code_information": [{"code": "6014-1418R", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED RT STM 8X12MM", "code_information": [{"code": "6014-0812R", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "REST HA TRI-SLOT 255MM BOWED RT STM 9X13MM", "code_information": [{"code": "6014-0913R", "type": "CDM"}], "standard_charges": [{"gross_charge": 18118.8, "discounted_cash": 4892.08, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 46MM", "code_information": [{"code": "1236-2-846", "type": "CDM"}], "standard_charges": [{"gross_charge": 4255.2, "discounted_cash": 1148.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 50MM", "code_information": [{"code": "1236-2-850", "type": "CDM"}], "standard_charges": [{"gross_charge": 4255.2, "discounted_cash": 1148.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 52MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1236-2-852", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1653.0, "discounted_cash": 446.31, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 54MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1236-2-854", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1653.0, "discounted_cash": 446.31, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 56MM", "code_information": [{"code": "1236-2-856", "type": "CDM"}], "standard_charges": [{"gross_charge": 4255.2, "discounted_cash": 1148.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 58MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1236-2-858", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4255.2, "discounted_cash": 1148.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 60MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1236-2-860", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4255.2, "discounted_cash": 1148.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 62MM", "code_information": [{"code": "1236-2-862", "type": "CDM"}], "standard_charges": [{"gross_charge": 4255.2, "discounted_cash": 1148.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION ADM X3 INSERT ID 28MM FOR CUP OD 64MM", "code_information": [{"code": "1236-2-864", "type": "CDM"}], "standard_charges": [{"gross_charge": 4255.2, "discounted_cash": 1148.9, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION GAP II ACET SHELL", "code_information": [{"code": "2082-0048L", "type": "CDM"}], "standard_charges": [{"gross_charge": 8878.8, "discounted_cash": 2397.28, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORATION GAP RING", "code_information": [{"code": "2083-0048", "type": "CDM"}], "standard_charges": [{"gross_charge": 7400.4, "discounted_cash": 1998.11, "setting": "both", "billing_class": "facility"}]}, {"description": "RESTORE/REMODEL VENTRICLE", "code_information": [{"code": "33548", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RETRACTOR 12MM ENDO PADDLE", "code_information": [{"code": "173046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 981.05, "discounted_cash": 264.88, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR 15MM HOHMANN  AR-8943-22", "code_information": [{"code": "AR-8943-22", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 221.0, "discounted_cash": 59.67, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR ACTBLR MUELLER MICROPLASTY", "code_information": [{"code": "31-555534", "type": "CDM"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR ACTBLR POSTERIOR", "code_information": [{"code": "31-555517", "type": "CDM"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 424.44, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR COBRA MICROPLASTY", "code_information": [{"code": "31-555532", "type": "CDM"}], "standard_charges": [{"gross_charge": 1350.0, "discounted_cash": 364.5, "setting": "both", "billing_class": "facility"}]}, {"description": "RETRACTOR CORD MAKO SILICONE", "code_information": [{"code": "111619", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 24.98, "discounted_cash": 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/REMVL CRTD SNS DEV 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/RPLCMT SK-MNT CRNL NSTM", "code_information": [{"code": "61891", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REV/RPLCT HPGLSL NSTM ARY PG", "code_information": [{"code": "64583", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRA LITHOTRIP-ATHER", "code_information": [{"code": "C9766", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC INTRAVASC LITHOTRIPSY", "code_information": [{"code": "C9764", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITH-STEN-ATH TIB/PER", "code_information": [{"code": "C9775", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTR-ATHER TIB/PER", "code_information": [{"code": "C9774", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": 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"AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVASC LITHOTRIP-STENT-ATHER", "code_information": [{"code": "C9767", "type": "HCPCS"}], 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"standard_charges": [{"gross_charge": 1953.0, "discounted_cash": 527.31, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSE FINGER KNUCKLE BENDER LG 15913-3", "code_information": [{"code": "15913-3", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.73, "discounted_cash": 20.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSE FINGER KNUCKLE BENDER MED 15913-2", "code_information": [{"code": "15913-2", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.73, "discounted_cash": 20.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSE FINGER KNUCKLE BENDER SM 15913-1", "code_information": [{"code": "15913-1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.73, "discounted_cash": 20.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSE FINGER KNUCKLE BENDER XLG 15913-4", "code_information": [{"code": "15913-4", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 75.73, "discounted_cash": 20.45, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED INSERT UHMWPE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF392B", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4269.0, "discounted_cash": 1152.63, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED TRAY CENTERED +12 DWF502", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5644.5, "discounted_cash": 1524.02, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED TRAY CENTERED +6 DWF501", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "DWF501", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2637.0, "discounted_cash": 711.99, "setting": "both", "billing_class": "facility"}]}, {"description": "REVERSED TRAY LOW OFFSET + 6 DWF511", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "DWF511", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2700.0, "discounted_cash": 729.0, "setting": "both", "billing_class": "facility"}]}, {"description": "REVIEW PATIENT SPIROMETRY", "code_information": [{"code": "94016", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32905", "type": 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1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE & REPAIR CHEST WALL", "code_information": [{"code": "32906", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ABDOMEN-VENOUS SHUNT", "code_information": [{"code": "49426", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE BLADDER & URETER(S)", "code_information": [{"code": "51565", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61705", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61708", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CIRCULATION TO HEAD", "code_information": [{"code": "61710", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE CORNEA WITH IMPLANT", "code_information": [{"code": "65770", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE ESOPHAGUS & STOMACH", "code_information": [{"code": "43325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE", "code_information": [{"code": "65091", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE", "code_information": [{"code": "67314", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE ADD-ON", "code_information": [{"code": "67340", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE MUSCLE(S)", "code_information": [{"code": "67318", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYE SOCKET IMPLANT", "code_information": [{"code": "67560", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67820", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELASHES", "code_information": [{"code": "67825", "type": "CPT"}], "standard_charges": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": "68360", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE EYELID LINING", "code_information": [{"code": 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GASTRIC PORT OPEN", "code_information": [{"code": "43886", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 15797.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 15797.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35879", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE GRAFT W/VEIN", "code_information": [{"code": "35881", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HEAD/NECK OF FEMUR", "code_information": [{"code": "27179", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE HERNIA & SPERM VEINS", "code_information": [{"code": "55540", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE LEG VEIN", "code_information": [{"code": "37700", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE MIDDLE EAR & MASTOID", "code_information": [{"code": "69646", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", 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5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54328", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PENIS/URETHRA", "code_information": [{"code": "54332", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE PROSTH VAG GRAFT LAP", "code_information": [{"code": "57426", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINAL CORD VSLS CRVL", "code_information": [{"code": "63250", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE SPINE CORD VSL THRLMB", "code_information": [{"code": "63252", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50727", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE URETER", "code_information": [{"code": "50728", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE WINDPIPE SCAR", "code_information": [{"code": "31830", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/GRAFT EYELID LINING", "code_information": [{"code": "68328", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISE/REMOVE ELECTRD ANTRUM", "code_information": [{"code": "43882", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33476", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33478", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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"plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33735", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33736", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HEART CHAMBER", "code_information": [{"code": "33737", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HIP BONE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HORSESHOE 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF HUMERUS", "code_information": [{"code": "24410", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF ILEOSTOMY", "code_information": [{"code": "44312", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF INFUSION PUMP", "code_information": [{"code": "36261", "type": "CPT"}], 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF LARYNX", "code_information": [{"code": "31400", "type": "CPT"}], "standard_charges": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33420", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "33422", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF MITRAL VALVE", "code_information": [{"code": "92987", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF NECK MUSCLE", "code_information": [{"code": "21725", "type": "CPT"}], "standard_charges": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF PENIS", "code_information": [{"code": "54304", "type": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF RECONSTRUCTED BREAST 19380", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 10027.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 16586.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF TRICUSPID VALVE", "code_information": [{"code": "33460", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF UPPER ARM", "code_information": [{"code": "24940", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION OF URETER", "code_information": [{"code": "50700", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", 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"gross_charge": 11238.0, "discounted_cash": 3034.26, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 8428.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3885.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION ORBITOFACIAL BONES", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL HIP ARTHROPLASTY ACETABULAR W/ OR W/O GRAFT 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL HIP ARTHROPLASTY BOTH COMPONENTS W/ OR W/O ALLOGRAFT 27134", "code_information": [{"code": "27134", "type": "CPT"}, {"code": "1744366", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 14224.5, "gross_charge": 18966.0, "discounted_cash": 5120.82, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 14224.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL HIP ARTHROPLASTY FEMORAL COMP. W/ OR W/O GRAFT 27138", "code_information": [{"code": "27138", "type": "CPT"}, {"code": "1807654", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 14224.5, "gross_charge": 18966.0, "discounted_cash": 5120.82, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 14224.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVISION TOTAL KNEE ARTHROPLASTY W/ OR W/O ALLOGRAFT 1 COMPONENT 27486", "code_information": [{"code": "27486", "type": "CPT"}, {"code": "1480021", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 9300.75, "gross_charge": 12401.0, "discounted_cash": 3348.27, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ RPLCMT/RMVL VRT TETHRG", "code_information": [{"code": "790T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBF", "code_information": [{"code": "819T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL INS PTN SUBQ", "code_information": [{"code": "818T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SAC W/NSTIM", "code_information": [{"code": "787T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REVJ/RMVL NEA SPI W/NSTIM", "code_information": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RLCJ PULSE GEN ONLY ISDSS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMP SK TC>=100", "code_information": [{"code": "69728", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV NTR OI IMPLT SKL PRQ 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV SK-MNT CRNL NSTM PG/RCVR", "code_information": [{"code": "61892", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PG WCS LV BATTERY", "code_information": [{"code": "520T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 33820.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMV&RPLCMT PHRNC NRV STIM PG", "code_information": [{"code": "33287", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 22671.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 22671.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPL CAR MODULJ PLS GN", "code_information": [{"code": "414T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 33820.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN 2 LEAD", "code_information": [{"code": "33263", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 48724.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 48724.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT DFB GEN MLT LD", "code_information": [{"code": "33264", "type": 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970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 48724.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL & RPLCMT TOT HRT SYS", "code_information": [{"code": "33928", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL ARTIFIC DISC ADDL CRVCL", "code_information": [{"code": "95T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "RMVL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62142", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL HPGLSL NSTIM ARY PG", "code_information": [{"code": "64584", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL IMED RX DELIVERY 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL OF SUBQ DEFIBRILLATOR", "code_information": [{"code": "33272", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 48724.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PHRNC NRV STIM SYS", "code_information": [{"code": "33278", "type": "CPT"}], 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL PROSTHHUMRL&ULNAR CMPNT", "code_information": [{"code": "24160", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL RPLCMT HRT SYS F/TRNSPL", "code_information": [{"code": "33929", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL SS IMPL DFB PG ONLY", "code_information": [{"code": "580T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL THYRD W/AUTOTRAN PARATH", "code_information": [{"code": "C7555", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8814.0, "setting": "outpatient", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL TONGS/HALO ANTHR INDIV", 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4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL& REPLC PULSE GEN 1 LEAD", "code_information": [{"code": "33262", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 48724.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 29691.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT IMPLT VSTBLR DEV", "code_information": [{"code": "727T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RMVL&RPLCMT SS IMPL DFB PG", "code_information": [{"code": "614T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 33820.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": 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{"description": "RNGLC CS 2-SHL GAUGES ALIGN GD SCR INSTR", "code_information": [{"code": "592031", "type": "CDM"}], "standard_charges": [{"gross_charge": 6579.0, "discounted_cash": 1776.33, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC CS 3-LINER PROVISIONALS INSTR", "code_information": [{"code": "592032", "type": "CDM"}], "standard_charges": [{"gross_charge": 6579.0, "discounted_cash": 1776.33, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC CUP INSERTER", "code_information": [{"code": "434540", "type": "CDM"}], "standard_charges": [{"gross_charge": 8085.0, "discounted_cash": 2182.95, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 20", "code_information": [{"code": "423330", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 21", "code_information": [{"code": "423331", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 22", "code_information": [{"code": "423332", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 23", "code_information": [{"code": "423333", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 24", "code_information": [{"code": "423334", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 25", "code_information": [{"code": "423335", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 26", "code_information": [{"code": "423336", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 27", "code_information": [{"code": "423337", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC FULL HEMI THRD IMPACTOR PLT SZ 28", "code_information": [{"code": "423338", "type": "CDM"}], "standard_charges": [{"gross_charge": 960.0, "discounted_cash": 259.2, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 20/40", "code_information": [{"code": "423630", "type": "CDM"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 21/41", "code_information": [{"code": "423631", "type": "CDM"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 22/42", "code_information": [{"code": "423632", "type": "CDM"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 23/43", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "423633", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 24/44", "code_information": [{"code": "423634", "type": "CDM"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 25/45", "code_information": [{"code": "423635", "type": "CDM"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 26/46", "code_information": [{"code": "423636", "type": "CDM"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 27/47", "code_information": [{"code": "423637", "type": "CDM"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC HI-WALL LNR IMPACTOR PLT SZ 28/48", "code_information": [{"code": "423638", "type": "CDM"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 89.1, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC INSERTER SCREW ROD", "code_information": [{"code": "434541", "type": "CDM"}], "standard_charges": [{"gross_charge": 663.0, "discounted_cash": 179.01, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LNR REMOVER", "code_information": [{"code": "423700", "type": "CDM"}], "standard_charges": [{"gross_charge": 8898.0, "discounted_cash": 2402.46, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 40", "code_information": [{"code": "423340", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 41", "code_information": [{"code": "423341", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 42", "code_information": [{"code": "423342", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 43", "code_information": [{"code": "423343", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 44", "code_information": [{"code": "423344", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 45", "code_information": [{"code": "423345", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 46", "code_information": [{"code": "423346", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 47", "code_information": [{"code": "423347", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC LP THRD IMPACTOR PLT SZ 48", "code_information": [{"code": "423348", "type": "CDM"}], "standard_charges": [{"gross_charge": 765.0, "discounted_cash": 206.55, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 40", "code_information": [{"code": "423660", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 41", "code_information": [{"code": "423661", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 42", "code_information": [{"code": "423662", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 43", "code_information": [{"code": "423663", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 44", "code_information": [{"code": "423664", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 45", "code_information": [{"code": "423665", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 46", "code_information": [{"code": "423666", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 47", "code_information": [{"code": "423667", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT LP SZ 48", "code_information": [{"code": "423668", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT SZ 20", "code_information": [{"code": "423650", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT SZ 21", "code_information": [{"code": "423651", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT SZ 22", "code_information": [{"code": "423652", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT SZ 23", "code_information": [{"code": "423653", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT SZ 24", "code_information": [{"code": "423654", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": "facility"}]}, {"description": "RNGLC SHL EXTCR PLT SZ 25", "code_information": [{"code": "423655", "type": "CDM"}], "standard_charges": [{"gross_charge": 1440.0, "discounted_cash": 388.8, "setting": "both", "billing_class": 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"423659", "type": "CDM"}], "standard_charges": [{"gross_charge": 375.0, "discounted_cash": 101.25, "setting": "both", "billing_class": "facility"}]}, {"description": "RNWT/BRSTN POR ACET SHL 48MM LNR SZ 22", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "106048", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6522.75, "discounted_cash": 1761.14, "setting": "both", "billing_class": "facility"}]}, {"description": "RNWT/BRSTN STARTER RMR-TAPERED", "code_information": [{"code": "428195", "type": "CDM"}], "standard_charges": [{"gross_charge": 1296.0, "discounted_cash": 349.92, "setting": "both", "billing_class": "facility"}]}, {"description": "ROBINUL 0.2MG/1ML INJ", "code_information": [{"code": "MED0330", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 42.67, "discounted_cash": 11.52, "setting": "both", "billing_class": "facility"}]}, {"description": "ROBOT LIN-RADSURG COM, FIRST", 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"setting": "both", "billing_class": "facility"}]}, {"description": "ROTATOR FEMORAL XL RIGHT KNEE HNG", "code_information": [{"code": "6481-1-141", "type": "CDM"}], "standard_charges": [{"gross_charge": 13305.6, "discounted_cash": 3592.51, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTATOR TIBL EXTRA SM SMALL MED COMPLEX HRHK", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "6481-2-100", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12275.55, "discounted_cash": 3314.4, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTATOR TIBL LG XL COMPLEX HRHK", "code_information": [{"code": "6481-2-101", "type": "CDM"}], "standard_charges": [{"gross_charge": 7841.4, "discounted_cash": 2117.18, "setting": "both", "billing_class": "facility"}]}, {"description": "ROTAVIRUS AG IA", "code_information": [{"code": "87425", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROTAVIRUS ANTIBODY", "code_information": [{"code": "86759", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 16.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUT FOOT CARE PER VISIT", "code_information": [{"code": "S0390", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ROUTER TROCHANTER TAPERED EXACT", "code_information": [{"code": "31-473190", "type": "CDM"}], "standard_charges": [{"gross_charge": 1056.0, "discounted_cash": 285.12, "setting": "both", "billing_class": "facility"}]}, {"description": "ROUTER VORTEX 4.5MM X 130MM 5 FLUTE BURR ARTHRO REPROCESS STERLING STRL", "code_information": [{"code": "H9131R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 86.13, "discounted_cash": 23.26, "setting": "both", "billing_class": "facility"}]}, {"description": "ROUTINE FOOTCARE PT W LOPS", "code_information": [{"code": "G0247", "type": "HCPCS"}], "standard_charges": [{"minimum": 695.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 1 AREA 1 D IMG", "code_information": [{"code": "78800", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 217.57, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM 2+AREA 1+D IMG", "code_information": [{"code": "78801", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 296.51, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 1 AREA", "code_information": [{"code": "78803", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 424.94, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1406.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT 2 AREAS", "code_information": [{"code": "78831", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1406.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 1", "code_information": [{"code": "78830", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1406.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM SPECT W/CT 2", "code_information": [{"code": "78832", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1578.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 1 D IMG", "code_information": [{"code": "78802", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 399.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1406.91, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP LOCLZJ TUM WHBDY 2+D IMG", "code_information": [{"code": "78804", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 747.6, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1406.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP QUAN MEAS SINGLE AREA", "code_information": [{"code": "78835", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RP THERAPY UNLISTED PX", "code_information": [{"code": "79999", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 264.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPL B1 FLP/PROSTC PLATE SKL", "code_information": [{"code": "62143", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE NO REVJ TRC", "code_information": [{"code": "43762", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC GTUBE REVJ GSTRST TRC", "code_information": [{"code": "43763", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLC OI IMPLT SK TC ESP>=100", "code_information": [{"code": "69730", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 12453.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 12453.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCM OI IMPLT SK TC ESP<100", "code_information": [{"code": "69719", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 12453.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 12453.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPLCMT A-VALVE TLCJ AUTOL PV", "code_information": [{"code": "33440", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR AA HRN RCR 3-10 NCR/STRN", "code_information": [{"code": "49616", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR CHOANAL ATRESIA TRSNPLTN", "code_information": [{"code": "30545", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR F/E/E/N/L/M >30.0 CM", "code_information": [{"code": "12018", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee 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"outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA 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total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR FEM HERNIA INIT BLOCKED", "code_information": [{"code": "49553", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR HERN PREEMIE REDUC", "code_information": [{"code": "49491", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR HYPSPAD COMP DSJ & URTP", "code_information": [{"code": "54348", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA BABY REDUC", "code_information": [{"code": "49495", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT BLOCKED", "code_information": [{"code": "49501", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR ING HERNIA INIT REDUCE", "code_information": [{"code": "49500", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH VERMILION ONLY", "code_information": [{"code": "40650", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR LIP FTH>1HALF VER HT/CPX", "code_information": [{"code": "40654", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR NSL VLV COLLAPSE W/IMPLT", "code_information": [{"code": "30468", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR PARASTOMAL HRNA NCR/STRN", "code_information": [{"code": "49622", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/A/GEN/TRK20.1-30.0CM", "code_information": [{"code": "12006", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": 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total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR S/N/AX/GEN/TRK7.6-12.5CM", "code_information": [{"code": "12004", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "RPR&REFIT SPCT PRSTH APHAKIA", "code_information": [{"code": "92371", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NX-3532K-SC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1687.89, "discounted_cash": 455.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW CUT 4.5MM MID 3.2 PROX HAMMERTOE CORRECTION", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "NX-4532K-SC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2106.0, "discounted_cash": 568.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SAW GUIDE PATELLA AGC", "code_information": [{"code": "32-467189", "type": "CDM"}], "standard_charges": [{"gross_charge": 4260.0, "discounted_cash": 1150.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SBRT DELIVERY", "code_information": [{"code": "77373", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": 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{"code": "AR 1978S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 410.4, "discounted_cash": 110.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SET GUIDE KNEE FOR MRI OR CT SCAN SIGNATURE", "code_information": [{"code": "42-422551", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2018.25, "discounted_cash": 544.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SET HANDPIECEINTERPULSE W/ 10FT SUCTION TUBE", "code_information": [{"code": "210100000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.29, "discounted_cash": 24.65, "setting": "both", "billing_class": "facility"}]}, {"description": "SET HIP W/ COAXIAL BONEINTERPLUS", "code_information": [{"code": "210-110-100", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 115.02, "discounted_cash": 31.06, "setting": "both", "billing_class": 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"code_information": [{"code": "2C8419", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 12.04, "discounted_cash": 3.25, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOLUTION CONTINU-FLO 3 2C8546", "code_information": [{"code": "2C8546", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 22.31, "discounted_cash": 6.02, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOLUTION INTERLINK CONTINU-FLO 3 IN 2C6546", "code_information": [{"code": "2C6546", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 20.88, "discounted_cash": 5.64, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SOLUTION INTERLINK INJ SITE LL 60DPM 2C6402", "code_information": [{"code": "2C6402", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 7.88, "discounted_cash": 2.13, "setting": "both", 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"discounted_cash": 24.18, "setting": "both", "billing_class": "facility"}]}, {"description": "SET SUTURE ANCHOR JUGGERKNOTLESS LOW PROFILE 2.1MM", "code_information": [{"code": "110003172", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1079.93, "discounted_cash": 291.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TBNG 8FT PT W/ A BACKFLOW RESTRICTOR AND TOUCH PROOF REDEUCE STRL", "code_information": [{"code": "AR-6421", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.75, "discounted_cash": 23.69, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TEMPLATE REV CALCAR W/ BOLT MALLORY HEAD", "code_information": [{"code": "104997", "type": "CDM"}], "standard_charges": [{"gross_charge": 138.0, "discounted_cash": 37.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SET TEMPLATE X RAY CALCAR MODULAR MALLORY HEAD", "code_information": 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"billing_class": "facility"}]}, {"description": "SHAFT REAMER PATELLAR W/ STOP VANGUARD", "code_information": [{"code": "32-486802", "type": "CDM"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT REAMER PATELLAR W/ XL STOP VANGUARD", "code_information": [{"code": "32-486809", "type": "CDM"}], "standard_charges": [{"gross_charge": 1200.0, "discounted_cash": 324.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 1.6MM MANUAL HPSINSTR", "code_information": [{"code": "320-1116", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 577.5, "discounted_cash": 155.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 1.8MM 3.5MM HEX CANN NONSTERILE 314.80", "code_information": [{"code": "314.8", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1213.74, "discounted_cash": 327.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 165MM STARDRV T25 SLF RETAINING", "code_information": [{"code": "314.119", "type": "CDM"}], "standard_charges": [{"gross_charge": 1081.58, "discounted_cash": 292.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 1MM CRUCIFORM SELF RETAINING", "code_information": [{"code": "313.991", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1891.5, "discounted_cash": 510.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2.4MM MANUAL HPSINSTR", "code_information": [{"code": "320-1124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 576.94, "discounted_cash": 155.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2.4MM STARDRV", "code_information": [{"code": "314.451", "type": "CDM"}], "standard_charges": [{"gross_charge": 1056.5, "discounted_cash": 285.26, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2.4MM X 100MM CRUCIFORM", "code_information": [{"code": "3.900.022", "type": "CDM"}], "standard_charges": [{"gross_charge": 830.78, "discounted_cash": 224.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2.5MM 100MM SM HEXAGONAL", "code_information": [{"code": "314.03", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 247.69, "discounted_cash": 66.88, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2.5MM HEXAGONAL CANNULATED", "code_information": [{"code": "314.1", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1145.93, "discounted_cash": 309.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 2MM MANUAL HPSINSTR", "code_information": [{"code": "320-1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 676.5, "discounted_cash": 182.66, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 4MM HEXAGONAL", "code_information": [{"code": "314.04", "type": "CDM"}], "standard_charges": [{"gross_charge": 793.16, "discounted_cash": 214.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 4MM HEXAGONAL CANNULATED", "code_information": [{"code": "314.23", "type": "CDM"}], "standard_charges": [{"gross_charge": 1225.79, "discounted_cash": 330.96, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER 4MM X 100MM HEX", "code_information": [{"code": "3.900.032", "type": "CDM"}], "standard_charges": [{"gross_charge": 843.32, "discounted_cash": 227.7, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER CRUCIFROM W/ HOLDING SLEEVE", "code_information": [{"code": "314.67.97", "type": "CDM"}], "standard_charges": [{"gross_charge": 2414.43, "discounted_cash": 651.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER LG HEXAGONAL", "code_information": [{"code": "314.15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 198.0, "discounted_cash": 53.46, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER QUICK COUPLING STARDRV T15", "code_information": [{"code": "314.116", "type": "CDM"}], "standard_charges": [{"gross_charge": 1128.6, "discounted_cash": 304.72, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER T25 100MM STARDRV", "code_information": [{"code": "3.900.042", "type": "CDM"}], "standard_charges": [{"gross_charge": 1169.36, "discounted_cash": 315.73, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER T40 100MM STARDRV", "code_information": [{"code": "3.900.044", "type": "CDM"}], "standard_charges": [{"gross_charge": 1103.52, "discounted_cash": 297.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCREWDRIVER T8 SLF HOLDING STARDRVINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "401.832.96", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 136.8, "discounted_cash": 36.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCRWDRVR 1.3MM CRUCIFORM SLF RETAINING FOR 1.3 MM TITANIUM CORTEX SCREW US", "code_information": [{"code": "313.992", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1679.6, "discounted_cash": 453.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCRWDRVR 105MM SLF RETAINING SLF HOLDING QUICK COUPLING FOR VAR ANGLE LOCK", "code_information": [{"code": "314.467", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1020.3, "discounted_cash": 275.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT SCRWDRVR SOLID CRUCIFORM QUICK COUPLING", "code_information": [{"code": "314.465", "type": "CDM"}], "standard_charges": [{"gross_charge": 815.1, "discounted_cash": 220.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAFT TIBLINTRAMEDULLARY RESECTION 0 DEGREE ASCENT", "code_information": [{"code": "32-379680", "type": "CDM"}], "standard_charges": [{"gross_charge": 1413.0, "discounted_cash": 381.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SHANK BALL PLUG PULLER VISION", "code_information": [{"code": "31-472004", "type": "CDM"}], "standard_charges": [{"gross_charge": 600.0, "discounted_cash": 162.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHANNON RECTA TM12013", "code_information": [{"code": "TM12013", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 966.9, "discounted_cash": 261.06, "setting": "both", "billing_class": "facility"}]}, {"description": "SHAVE EPIDERMAL/DERMAL LESION SINGLE FACE/EAR/NOSE/LIP 0.5CM OR LESS 11310", "code_information": [{"code": "11310", "type": "CPT"}, {"code": "1703014", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "gross_charge": 4437.0, "discounted_cash": 1197.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION 1.1-2.0 CM", "code_information": [{"code": "11312", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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"UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHAVE SKIN LESION >2.0 CM", "code_information": [{"code": "11313", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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[{"gross_charge": 300.0, "discounted_cash": 81.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM SPACER 5MM VANGUARD 360", "code_information": [{"code": "32-360901", "type": "CDM"}], "standard_charges": [{"gross_charge": 300.0, "discounted_cash": 81.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TIBL 0MM LFT MEDIAL CAPTURED OXFORD", "code_information": [{"code": "32-423222", "type": "CDM"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 130.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TIBL 0MM LFT MEDIAL OXFORD", "code_information": [{"code": "32-422988", "type": "CDM"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 106.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TIBL 0MM RIGHT MEDIAL CAPTURED OXFORD", "code_information": [{"code": "32-423223", "type": "CDM"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 130.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TIBL 0MM RIGHT MEDIAL OXFORD", "code_information": [{"code": "32-422985", "type": "CDM"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 106.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TIBL 2MM LFT MEDIAL CAPTURED OXFORD", "code_information": [{"code": "32-423231", "type": "CDM"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 130.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TIBL 2MM LFT MEDIAL OXFORD", "code_information": [{"code": "32-422990", "type": "CDM"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 108.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TIBL 2MM RIGHT MEDIAL CAPTURED OXFORD", "code_information": [{"code": "32-423230", "type": "CDM"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 130.41, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIM TIBL 2MM RIGHT MEDIAL OXFORD", "code_information": [{"code": "32-422987", "type": "CDM"}], "standard_charges": [{"gross_charge": 402.0, "discounted_cash": 108.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIMINSTR 2MM METAL OXFORD", "code_information": [{"code": "32-420664", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHIMINSTR 3MM METAL OXFORD", "code_information": [{"code": "32-420665", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SHL GAUGE HANDLE W/45 DEG", "code_information": [{"code": "423617", "type": "CDM"}], "standard_charges": [{"gross_charge": 1854.0, "discounted_cash": 500.58, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE FOOT POST OP MED UNIV LF NYLON RUBBER SQUARE TOE NS", "code_information": [{"code": "79-81235", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.14, "discounted_cash": 7.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE HEALING LG WOMEN POST OPERATION ORTHOWEDGE", "code_information": [{"code": "OQ3B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 72.68, "discounted_cash": 19.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE HEALING XL POST OPERATION ORTHOWEDGE", "code_information": [{"code": "OW4B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 65.25, "discounted_cash": 17.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE PATIENT XL FEMALE POST OP", "code_information": [{"code": "WQW48", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.01, "discounted_cash": 11.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP HOOK AND LOOP MENS LARGE", "code_information": [{"code": "69-1024-000", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP HOOK AND LOOP MENS MEDIUM", "code_information": [{"code": "69-1023-000", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP HOOK AND LOOP MENS SMALL", "code_information": [{"code": "69-1022-000", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP HOOK AND LOOP MENS XL", "code_information": [{"code": "69-1025-000", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP HOOK AND LOOP WOMENS LARGE", "code_information": [{"code": "69-1028-000", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP HOOK AND LOOP WOMENS MEDIUM", "code_information": [{"code": "69-1027-000", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP HOOK AND LOOP WOMENS SMALL", "code_information": [{"code": "69-1026-000", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 27.2, "discounted_cash": 7.34, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LG 8 TO 10 BLUE FEM OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FOAM", "code_information": [{"code": "79-90197", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 24.03, "discounted_cash": 6.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LG ORTHO", "code_information": [{"code": "POS-3 LARGE", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.01, "discounted_cash": 11.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LG SHOE SZ 10.5 TO 12 BLACK MENS SQUARE TOE STRAPLESS FOREFOOT CLOS", "code_information": [{"code": "MQM3B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 45.25, "discounted_cash": 12.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LG SHOE SZ 11 TO 13 BLUE MALE OPEN TOE CLOSED HEEL HOOK AND LOOP CL", "code_information": [{"code": "79-90187", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 24.03, "discounted_cash": 6.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP LRG UNIV LF NYLON RUBBER SQUARE TOE NS", "code_information": [{"code": "79-81237", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.14, "discounted_cash": 7.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP MED 6 TO 8 BLUE FEM OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FOAM", "code_information": [{"code": "79-90195", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 24.03, "discounted_cash": 6.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP MED 9 TO 11 BLUE MALE OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FO", "code_information": [{"code": "79-90185", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 24.03, "discounted_cash": 6.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SM 4 TO 6 BLACK FEMALE STRAPLESS FOREFOOT CLOSURE", "code_information": [{"code": "MQW1B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 46.07, "discounted_cash": 12.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SM 4 TO 6 BLACK WOMENS SQUARE TOE STRAPLESS FOREFOOT CLOSURE", "code_information": [{"code": "MQW3B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 42.63, "discounted_cash": 11.51, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SM 4 TO 6 BLUE FEM OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FOAM", "code_information": [{"code": "79-90193", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 24.03, "discounted_cash": 6.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SM 7 TO 9 BLUE MALE OPEN TOE CLOSED HEEL HOOK AND LOOP CLOSURE FOAM", "code_information": [{"code": "79-90183", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 24.03, "discounted_cash": 6.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SM ORTHO", "code_information": [{"code": "POS-1 SMALL", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 43.01, "discounted_cash": 11.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP SML UNIV LF NYLON RUBBER SQUARE TOE NS", "code_information": [{"code": "79-81233", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.69, "discounted_cash": 7.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP X-SML UNIV LF NYLON RUBBER SQUARE TOE NS", "code_information": [{"code": "79-81232", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 29.14, "discounted_cash": 7.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP XL MALE CLOSED HEAL ROCKER SOLE LOOP LOCK OPEN TOE LACE UP FOAM NYL", "code_information": [{"code": "79-90188", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST OP XL ORTHO", "code_information": [{"code": "POS-4 XLARGE", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 42.85, "discounted_cash": 11.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POST-OP SQUARE TOE X-LARGE", "code_information": [{"code": "79-81238", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 27.69, "discounted_cash": 7.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POSTOPERATIVE MED BLACK MALE STRAPLESS CLOSURE NYLON", "code_information": [{"code": "MQM2B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 46.07, "discounted_cash": 12.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POSTOPERATIVE MED MEN", "code_information": [{"code": "POS-2 MM", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.01, "discounted_cash": 11.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POSTOPERATIVE MED WOMEN", "code_information": [{"code": "POS-2 MEDIUM", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.01, "discounted_cash": 11.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POSTOPERATIVE MED WOMEN LFT RIGHT FIT SQUARE TOE ANKLE STRP ORTHOWEDGE", "code_information": [{"code": "OQ2B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 65.25, "discounted_cash": 17.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POSTOPERATIVE SM BLACK MALE STRAPLESS CLOSURE NYLON", "code_information": [{"code": "MQM1B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 43.01, "discounted_cash": 11.61, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE POSTOPERATIVE SM WOMEN LFT RIGHT FIT SQUARE TOE ANKLE STRP ORTHOWEDGE", "code_information": [{"code": "OQ1B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 65.25, "discounted_cash": 17.62, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE SURG MED BLACK WOMEN EXTRA LNG STRAPS NYLON", "code_information": [{"code": "MQW2B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 50.27, "discounted_cash": 13.57, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOE SURG XL BLACK MALE STRAPLESS CLOSURE NYLON", "code_information": [{"code": "MQM4B", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 52.02, "discounted_cash": 14.05, "setting": "both", "billing_class": "facility"}]}, {"description": "SHOECOVER ANTI SKID", "code_information": [{"code": "2854", "type": "CDM"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORT THREAD SCREW HEADLESS 7.0 X 74MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "P20-570-074S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2247.48, "discounted_cash": 606.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SHORTEN RADIUS & ULNA", "code_information": [{"code": "25392", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SHORTEN/LENGTHEN THIGHS", "code_information": [{"code": "27468", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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[{"code": "144-00032", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1620.0, "discounted_cash": 437.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE DRILL 100MM TS 4.8 VISION", "code_information": [{"code": "14-400036", "type": "CDM"}], "standard_charges": [{"gross_charge": 1620.0, "discounted_cash": 437.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE DRILL 125MM TS 4.8 VISION", "code_information": [{"code": "14-400037", "type": "CDM"}], "standard_charges": [{"gross_charge": 1620.0, "discounted_cash": 437.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE DRILL 1MM X 1.3MM DOUBLE", "code_information": [{"code": "319.134", "type": "CDM"}], "standard_charges": [{"gross_charge": 1009.47, "discounted_cash": 272.56, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE DRILL 2.5MM CLIP ON FOR 3.607.110", "code_information": [{"code": "C1713", 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"standard_charges": [{"gross_charge": 7852.65, "discounted_cash": 2120.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE FEMORAL 34MM POROUS UNIVERSAL", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "129453226", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9254.7, "discounted_cash": 2498.77, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE FEMORAL 34MM UNIVERSAL DIST POROUS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "129453225", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7852.65, "discounted_cash": 2120.22, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE FEMORAL 40MM FULLY POROUS UNIVERSAL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "129453236", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9254.7, 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"272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.72, "discounted_cash": 1.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE HOLDING  FOR CANNULATED CLICKX PREASSEMBLED 314.069", "code_information": [{"code": "314.069", "type": "CDM"}], "standard_charges": [{"gross_charge": 1900.11, "discounted_cash": 513.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE HOLDING FOR 3 MM CANNULATED SCREWDRIVER", "code_information": [{"code": "313.969", "type": "CDM"}], "standard_charges": [{"gross_charge": 2198.3, "discounted_cash": 593.54, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE HOLDING FOR SM HEXAGONAL SCREWDRIVER SHAFTS AND CANNULATED HEXAGONAL SCRE", "code_information": [{"code": "314.06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 532.95, "discounted_cash": 143.9, "setting": "both", "billing_class": "facility"}]}, {"description": "SLEEVE HOLDING SM 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SLITTING OF PREPUCE", "code_information": [{"code": "54001", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SMALL BOWEL ENDOSCOPY", "code_information": [{"code": "44363", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": 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"code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "12-Nov", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14250.0, "discounted_cash": 3847.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LEVA 22 X 10 X 12MM EXPANDABLE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "12-Nov", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14250.0, "discounted_cash": 3847.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LEVA EXPANDABLE 10MM X 25MM X 10MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "10-Nov", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 14250.0, "discounted_cash": 3847.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LEVA EXPANDABLE 11MM X 25MM X 10MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "11-7011 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"standard_charges": [{"gross_charge": 14250.0, "discounted_cash": 3847.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LLIF 9MM 0DEG EXTRA SM LAT LUMBARINTERBODY FUSION PEEK TRANSCONTINENTAL", "code_information": [{"code": "CP260609", "type": "CDM"}], "standard_charges": [{"gross_charge": 417.0, "discounted_cash": 112.59, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LORDORIC 15MM X 15MM X 6MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "37-5006SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5250.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LORDORIC 15MM X 15MM X 7MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "37-5007SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LORDORIC 15MM X 15MM X 8MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "37-5008SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5250.0, "discounted_cash": 1417.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LORDOTIC 38MM X 30MM X 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1129-383-015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17250.0, "discounted_cash": 4657.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER LORDOTIC 38MM X 30MM X 17MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1129-383-017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17250.0, "discounted_cash": 4657.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER MAGNETIC 5MM 360 DEGREE VANGAURD", "code_information": [{"code": "32-360108", "type": "CDM"}], "standard_charges": [{"gross_charge": 108.0, "discounted_cash": 29.16, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER METACARPOPPHALANGEAL SZ 10 SILICONE MCP ASCENSION", "code_information": [{"code": "L8658", "type": "HCPCS"}, {"code": "SMCP50010WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4140.0, "discounted_cash": 1117.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER METACARPOPPHALANGEAL SZ 20 SILICONE MCP ASCENSION", "code_information": [{"code": "L8658", "type": "HCPCS"}, {"code": "SMCP50020WW", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4140.0, "discounted_cash": 1117.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER NECK BIO-MOORE II BI-POLAR", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "31-482554", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 489.0, "discounted_cash": 132.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER NECK PROVISIONAL WRENCH BIO-MOORE II", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "31-482556", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1296.0, "discounted_cash": 349.92, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER OSTEONICS UNIV. DISTAL SPACER 1067-0012", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "1067-0012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 448.2, "discounted_cash": 121.01, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PATELLA 10.0MM VANGUARD", "code_information": [{"code": "32-486878", "type": "CDM"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 424.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PATELLA 6.2MM VANGUARD", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "32-486870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 424.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PATELLA 7.8MM VANGUARD", "code_information": [{"code": "32-486872", "type": "CDM"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 424.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PATELLA 8.0MM VANGUARD", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "32-486874", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 424.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PATELLA 8.5MM VANGUARD", "code_information": [{"code": "32-486876", "type": "CDM"}], "standard_charges": [{"gross_charge": 1572.0, "discounted_cash": 424.44, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK 40X28X18MM PILAR SA", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "49-3218", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 20073.0, "discounted_cash": 5419.71, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK OPTIMA SHORT TI 10MM", "code_information": [{"code": "60210", "type": "CDM"}], "standard_charges": [{"gross_charge": 6.49, "discounted_cash": 1.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PEEK PILLAR 33MM X 28MM X 14MM 7 DEG", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "49-9014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 17250.0, "discounted_cash": 4657.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PROXIMAL TIBIAL 15MM HALF 15-2990/07", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15-2990/07", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5115.36, "discounted_cash": 1381.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER PROXIMAL TIBIAL MKPS HALF HEX 2.5MM 15-2990/09", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "15-2990/09", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5115.36, "discounted_cash": 1381.15, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER REVERSED 42 MM +9 MM DWB932", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "DWB932", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4042.5, "discounted_cash": 1091.48, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SHOULDER ANTIBIOTIC KIT SMALL", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "SPS0121K", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 13500.0, "discounted_cash": 3645.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL 11MM X 27MM X 14MM FORZA IMP", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "894014SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10200.0, "discounted_cash": 2754.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPINAL 11MM X 27MM X 16MM 0DEG", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "89-4016SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10200.0, "discounted_cash": 2754.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SPNL 9MM X 27MM X 12MM 0DEG BULLET TIP DESIGN PEEK FORZA STRL IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "89-3012SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10200.0, "discounted_cash": 2754.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER STRAIGHT FORZA 11 X 27 X 11MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "89-4011SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10200.0, "discounted_cash": 2754.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER STRAIGHT FORZA 9 X 27 X 8MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "89-3008SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 2430.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER SYSTEM FORZA 9 X 27 X 14MM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "89-3014SP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 10200.0, "discounted_cash": 2754.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TAPERED 10 BY 12 POSITIVE 0", "code_information": [{"code": "136334000", "type": "CDM"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TAPERED 10 BY 12 POSITIVE 10", "code_information": [{"code": "136336000", "type": "CDM"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TAPERED 10 BY 12 POSITIVE 5", "code_information": [{"code": "136335000", "type": "CDM"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TAPERED NEGATIVE 3 ARTICULEZE", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "136308000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TAPERED POSITIVE 0 ARTICULEZE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "136310000", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TAPERED POSITIVE 10 ARTICULEZE", "code_information": [{"code": "136314000", "type": "CDM"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TAPERED POSITIVE 5 ARTICULEZE", "code_information": [{"code": "136312000", "type": "CDM"}], "standard_charges": [{"gross_charge": 450.0, "discounted_cash": 121.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TI6A14V", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "ARS342002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8119.5, "discounted_cash": 2192.27, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TI6A14V 15MM 20MM AEQUALIS FLEX REVIVE  ARS342004", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "ARS342004", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7732.5, "discounted_cash": 2087.78, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TIBIAL MOLD 39AP X 58ML SMALL", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "689-2058", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5550.0, "discounted_cash": 1498.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPACER TIBIAL MOLD 44AP X 67ML MEDIUM", "code_information": [{"code": "L8699", "type": "HCPCS"}, {"code": "669-1067", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6180.0, "discounted_cash": 1668.6, "setting": "both", "billing_class": "facility"}]}, {"description": "SPADE DRILL BIT FOR 2.9 ANCHOR 72201395", "code_information": [{"code": "72201395", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 484.5, "discounted_cash": 130.82, "setting": "both", "billing_class": "facility"}]}, {"description": "SPANNER WRENCH", "code_information": [{"code": "321.25", "type": "CDM"}], "standard_charges": [{"gross_charge": 802.56, "discounted_cash": 216.69, "setting": "both", "billing_class": "facility"}]}, {"description": "SPARE CENTERING PIN FOR HOLLOW REAMER 309.270", "code_information": [{"code": "309.27", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 377.3, "discounted_cash": 101.87, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEAR SURGINSTR", "code_information": [{"code": "ASSI5335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.49, "discounted_cash": 3.37, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEARS WECK-CELL  0008685", "code_information": [{"code": "8685", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99190", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99191", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL PUMP SERVICES", "code_information": [{"code": "99192", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION DOSIMETRY", "code_information": [{"code": "77331", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 28.17, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL RADIATION TREATMENT", "code_information": [{"code": "77470", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 172.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIAL REPORTS OR FORMS", "code_information": [{"code": "99080", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"AETNA WHOLE HEALTH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 39.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIALIST PAD 2 X 4 9062", "code_information": [{"code": "9062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": 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"99000", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5.02, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECIMEN INFECT AGNT CONCNTJ", "code_information": [{"code": "87015", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 6.01, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPECTROPHOTOMETRY", "code_information": [{"code": "84311", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH AUDIOMETRY COMPLETE", "code_information": [{"code": "92556", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH EVALUATION COMPLEX", "code_information": [{"code": "70371", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 77.1, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH SOUND LANG COMPREHEN", "code_information": [{"code": "92523", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEECH/HEARING THERAPY", "code_information": [{"code": "92508", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 57.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPEED BRIDGE IMPLANT SYSTEM AR-2600SBS-6", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-2600SBS-6", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 6450.0, "discounted_cash": 1741.5, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEED CINCH CURVED NEEDLE IMP 2 FWIRE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-4502", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1185.0, "discounted_cash": 319.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDBRIDGE ACHILLIES SYSTEM BIO-COMP MID-SUBSTANCE", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "AR-8929BC-CP", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3170.7, "discounted_cash": 856.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDPLATE HYBRID SK5152", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK5152", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11985.0, "discounted_cash": 3235.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDPLATE HYBRID SK5153", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK5153", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11985.0, "discounted_cash": 3235.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPEEDPLATE KIT LAPIPLASTY  HYBRID QUAD SK50 AND SK53 SK5053", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SK5053", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11985.0, "discounted_cash": 3235.95, "setting": "both", "billing_class": "facility"}]}, {"description": "SPERM ANTIBODY TEST", "code_information": [{"code": "89325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 9.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM EVALUATION TEST", "code_information": [{"code": "89329", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 17.63, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM IDENTIFICATION", "code_information": [{"code": "89257", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION COMPLEX", "code_information": [{"code": "89261", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM ISOLATION SIMPLE", "code_information": [{"code": "89260", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPERM WASHING", "code_information": [{"code": "58323", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPHENOID SINUS SURGERY", "code_information": [{"code": "31051", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": 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{"description": "SPINDLE ANTI ROTATION 800 POUND EXTRA SM 30MM SHRT W/ PINS COMPRESS IMP", "code_information": [{"code": "178364", "type": "CDM"}], "standard_charges": [{"gross_charge": 10122.0, "discounted_cash": 2732.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE ANTI ROTATION 800 POUND EXTRA SM W/ PINS COMPRESS IMP", "code_information": [{"code": "178352", "type": "CDM"}], "standard_charges": [{"gross_charge": 10122.0, "discounted_cash": 2732.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE ANTI ROTATION 800 POUND LG 44MM SHRT W/ PINS COMPRESS IMP", "code_information": [{"code": "178370", "type": "CDM"}], "standard_charges": [{"gross_charge": 10122.0, "discounted_cash": 2732.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE ANTI ROTATION 800 POUND LG W/ PINS COMPRESS IMP", "code_information": [{"code": "178358", "type": "CDM"}], "standard_charges": [{"gross_charge": 10122.0, "discounted_cash": 2732.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE ANTI ROTATION 800 POUND SHRT ELLIPTICAL W/ PINS COMPRESS IMP", "code_information": [{"code": "178373", "type": "CDM"}], "standard_charges": [{"gross_charge": 10122.0, "discounted_cash": 2732.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE ANTI ROTATION 800 POUND SM 38MM SHRT W/ PINS COMPRESS IMP", "code_information": [{"code": "178367", "type": "CDM"}], "standard_charges": [{"gross_charge": 10122.0, "discounted_cash": 2732.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE ANTI ROTATION 800 POUND SM W/ PINS COMPRESS IMP", "code_information": [{"code": "178355", "type": "CDM"}], "standard_charges": [{"gross_charge": 10122.0, "discounted_cash": 2732.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE ANTI ROTATION 800 POUNDS ELLIPTICAL W/ PINS COMPRESS IMP", "code_information": [{"code": "178361", "type": "CDM"}], "standard_charges": [{"gross_charge": 10122.0, "discounted_cash": 2732.94, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE FEMRL 400 POUND LG W/ HYDROXYAPATITE FOR COMPRESS COMPLIANT PRESTREESS D", "code_information": [{"code": "178488", "type": "CDM"}], "standard_charges": [{"gross_charge": 10704.0, "discounted_cash": 2890.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE FEMRL LG 600 POUND W/ HYDROXYAPATITE FOR COMPRESS COMPLIANT PRESTREESS D", "code_information": [{"code": "178496", "type": "CDM"}], "standard_charges": [{"gross_charge": 10704.0, "discounted_cash": 2890.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE FEMRL SM 400 POUND W/ HYDROXYAPATITE FOR COMPRESS COMPLIANT PRESTREESS D", "code_information": [{"code": "178464", "type": "CDM"}], "standard_charges": [{"gross_charge": 10704.0, "discounted_cash": 2890.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE FEMRL SM 600 POUND W/ HYDROXYAPATITE FOR COMPRESS COMPLIANT PRESTREESS D", "code_information": [{"code": "178472", "type": "CDM"}], "standard_charges": [{"gross_charge": 10704.0, "discounted_cash": 2890.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINDLE FEMRL SM 800 POUND W/ HYDROXYAPATITE FOR COMPRESS COMPLIANT PRESTREESS D", "code_information": [{"code": "178480", "type": "CDM"}], "standard_charges": [{"gross_charge": 10704.0, "discounted_cash": 2890.08, "setting": "both", "billing_class": "facility"}]}, {"description": "SPINE DEVICE IMPLANT SURGERY", "code_information": [{"code": "C9757", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE DISK SURGERY THORAX", "code_information": [{"code": "63077", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPINE JACK EXPANSION KIT 5.0  0909-200-050", "code_information": [{"code": "C1713", "type": "HCPCS"}, 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"RC"}], "standard_charges": [{"gross_charge": 19.98, "discounted_cash": 5.39, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETERINCENTIVE VOLUMETRIC", "code_information": [{"code": "DHD224000", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.23, "discounted_cash": 12.75, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETERS VYAIRE AIRLIFE VOLUMETRIC INCENTIVE  BXT001901A", "code_information": [{"code": "BXT001901A", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.38, "discounted_cash": 3.07, "setting": "both", "billing_class": "facility"}]}, {"description": "SPIROMETRY UP TO 2 YRS OLD", "code_information": [{"code": "94011", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLICE SPLEEN/KIDNEY VEINS", "code_information": [{"code": "37181", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SPLICING OF URETERS", "code_information": [{"code": "50770", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 38250.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 41468.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SRS CRANIAL LESION COMPLEX", "code_information": [{"code": "61798", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 41468.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 38250.0, "methodology": "case rate"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 41468.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "SRS SPINAL LESION ADDL", "code_information": [{"code": "63621", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 41468.0, "setting": "outpatient", "payers_information": 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"STEM TRIATHLON 12MM X 100MM CEMENTLESS TI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-012", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5556.6, "discounted_cash": 1500.28, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TRIATHLON 13MM X 100MM CEMENTLESS TI", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-013", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TRIATHLON 16MM X 100MM CEMENTLESS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-016", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5556.6, "discounted_cash": 1500.28, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TRIATHLON 17MM X 100MM CEMENTLESS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5556.6, "discounted_cash": 1500.28, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TRIATHLON 18MM X 100MM CEMENTLESS PRESS FIT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-018", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5556.6, "discounted_cash": 1500.28, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM TRIATHLON 22MM X 100MM CEMENTLESS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "5565-S-022", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5040.0, "discounted_cash": 1360.8, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM ULNAR 41MM SM SHRT RIGHT IMP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "30010", "type": 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6000.0, "discounted_cash": 1620.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM ZVPLASY UNIPEDICULAR KYPHOPLASTY SY15MM BALLOON VCF-1015-1G", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "VCF-1015-1G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 8400.0, "discounted_cash": 2268.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM- HIGH  INSIGNIA HIP OFFSET 7000-6604", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7000-6604", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5272.5, "discounted_cash": 1423.58, "setting": "both", "billing_class": "facility"}]}, {"description": "STEM- HIGH OFFSET SIZE 8 INSIGNIA HIP  7000-6608", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "7000-6608", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5272.5, "discounted_cash": 1423.58, "setting": "both", "billing_class": "facility"}]}, {"description": "STENGER TEST PURE TONE", "code_information": [{"code": "92565", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "STENGER TEST SPEECH", "code_information": [{"code": "92577", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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{"description": "STEP WEDGE 10 D SZ 2.5 MODUKAR HEMI TIBL PFC", "code_information": [{"code": "860378", "type": "CDM"}], "standard_charges": [{"gross_charge": 4847.7, "discounted_cash": 1308.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STEP WEDGE 10MM SZ 2.5 MODULAR TIBL PFC", "code_information": [{"code": "860380", "type": "CDM"}], "standard_charges": [{"gross_charge": 4847.7, "discounted_cash": 1308.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STEP WEDGE 15MM SZ 1.5 MODULAR TIBL PFC", "code_information": [{"code": "860374", "type": "CDM"}], "standard_charges": [{"gross_charge": 4847.7, "discounted_cash": 1308.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STEP WEDGE 15MM SZ 2.5 MODULAR TIBL PFC", "code_information": [{"code": "860381", "type": "CDM"}], "standard_charges": [{"gross_charge": 4847.7, "discounted_cash": 1308.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STEP WEDGE 20 D SZ 2.5 MODULAR HEMI TIBL PFC", "code_information": [{"code": "860379", "type": "CDM"}], "standard_charges": [{"gross_charge": 4847.7, "discounted_cash": 1308.88, "setting": "both", "billing_class": "facility"}]}, {"description": "STEPDRILL SOLID FOR LAG SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "1806-3026S", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 493.31, "discounted_cash": 133.19, "setting": "both", "billing_class": "facility"}]}, {"description": "STEREOISOMER ANALYSIS", "code_information": [{"code": "80374", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"description": "STIMULATOR EXTERNAL TRIAL  1601 Axonic", "code_information": [{"code": "C1897", "type": "HCPCS"}, {"code": "1601 Axonic", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 660.0, "discounted_cash": 178.2, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR GROWTH BONE PHYSIO-STIM", "code_information": [{"code": "653202-0015", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 9000.0, "discounted_cash": 2430.0, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR IMAGEREADY MR CONDITIONAL SPINAL CORD  SC-5590", "code_information": [{"code": "C1787", "type": "HCPCS"}, {"code": "SC-5590", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2550.0, "discounted_cash": 688.5, "setting": "both", "billing_class": "facility"}]}, {"description": "STIMULATOR NEURO FREEDOM 8 A TRIAL", "code_information": [{"code": "C1897", 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF UTERUS", "code_information": [{"code": "58410", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "SUSPENSION OF VAGINA", "code_information": [{"code": "57280", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": 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{"description": "SUTURE  0 36 PDS PLUS VIO MONO CT1 PDP346H", "code_information": [{"code": "PDP346H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.49, "discounted_cash": 3.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 36IN COATED VICRYL PLUS UND VCP946H", "code_information": [{"code": "VCP946H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.77, "discounted_cash": 2.1, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 60 PDS PLUS VIO MONO CTX PDP990G", "code_information": [{"code": "PDP990G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.3, "discounted_cash": 6.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  0 618IN COATED VICRYL UND BRAID VCP112G", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "VCP112G", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 12.19, "discounted_cash": 3.29, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 27 PDS PLUS VIO MONO CP1 PDP468H", "code_information": [{"code": "PDP468H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.89, "discounted_cash": 3.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 27 PDS PLUS VIO MONO CT1 PDP341H", "code_information": [{"code": "PDP341H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.88, "discounted_cash": 3.21, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 27IN COATED VICRYL VIL CT2 VCP335H", "code_information": [{"code": "VCP335H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.5, "discounted_cash": 2.03, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 27IN COATED VICRYL VIL CTX VCP365H", "code_information": [{"code": "VCP365H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.54, "discounted_cash": 2.04, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 36 PDS PLUS VIO MONO CT1 PDP347H", "code_information": [{"code": "PDP347H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.16, "discounted_cash": 3.28, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 36 PDS PLUS VIO MONO CTX PDP371T", "code_information": [{"code": "PDP371T", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 12.25, "discounted_cash": 3.31, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 36IN COATED VICRYL UND CTX VCP977H", "code_information": [{"code": "VCP977H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.02, "discounted_cash": 2.17, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 48 PDS PLUS VIO MONO TP1 PDP880G", "code_information": [{"code": "PDP880G", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 20.32, "discounted_cash": 5.49, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 818 CTD VIC UND BR CTX JB725", "code_information": [{"code": "JB725", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.9, "discounted_cash": 12.93, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 818 CTD VIC VIO BR CTX J765D", "code_information": [{"code": "J765D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 47.26, "discounted_cash": 12.76, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  1 827IN COATED VICRYL UND CR CT VCPP40D", "code_information": [{"code": "VCPP40D", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.69, "discounted_cash": 14.23, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2 27IN COATED VICRYL UND CP VCP195H", "code_information": [{"code": "VCP195H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.8, "discounted_cash": 2.38, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 CTD VIC VIO BR UR J375H", "code_information": [{"code": "J375H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 8.4, "discounted_cash": 2.27, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 PDS PLUS CLR MONO CT1 PDP259H", "code_information": [{"code": "PDP259H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.59, "discounted_cash": 2.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 PDS PLUS VIO MONO CT1 PDP339H", "code_information": [{"code": "PDP339H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.58, "discounted_cash": 2.86, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 PDS PLUS VIO MONO CT2 PDP333H", "code_information": [{"code": "PDP333H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.44, "discounted_cash": 3.09, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  2/0 27 PDS PLUS VIO MONO SH PDP317H", "code_information": [{"code": "PDP317H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.76, "discounted_cash": 2.91, "setting": "both", "billing_class": "facility"}]}, {"description": "SUTURE  3/0 27 PDS PLUS VIO MONO CT1 PDP338H", "code_information": [{"code": "PDP338H", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.34, "discounted_cash": 3.06, "setting": "both", 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6430.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAMP BEVEKLED", "code_information": [{"code": "359.206", "type": "CDM"}], "standard_charges": [{"gross_charge": 645.81, "discounted_cash": 174.37, "setting": "both", "billing_class": "facility"}]}, {"description": "TAMP STANDARDINSTR", "code_information": [{"code": "359.205", "type": "CDM"}], "standard_charges": [{"gross_charge": 645.81, "discounted_cash": 174.37, "setting": "both", "billing_class": "facility"}]}, {"description": "TANGNTL BX SKIN EA SEP/ADDL", "code_information": [{"code": "11103", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BLOCK UNI BY INFUSION", "code_information": [{"code": "64487", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TAP BONE", "code_information": [{"code": "35-463112", "type": "CDM"}], "standard_charges": [{"gross_charge": 4467.0, "discounted_cash": 1206.09, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BONE 2.7MM RAYHACK", "code_information": [{"code": "40100627", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.6, "discounted_cash": 67.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BONE 3.5MM RAYHACK", "code_information": [{"code": "40100635", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.6, "discounted_cash": 67.93, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BONE CANNULATED 5MM 705254", "code_information": [{"code": "705254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1141.27, "discounted_cash": 308.14, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP BONE FOR 4 MM SCREW", "code_information": [{"code": "11-104042", "type": "CDM"}], "standard_charges": [{"gross_charge": 8007.0, "discounted_cash": 2161.89, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANCELLOUS SCREWS 6.5MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "700449", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1062.3, "discounted_cash": 286.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED 200MM TAP DEPTH FOR 6.5 MM AND 7.3 MM CANNULATED SCREW", "code_information": [{"code": "311.689", "type": "CDM"}], "standard_charges": [{"gross_charge": 1991.44, "discounted_cash": 537.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED 7.0 MM LARGE AO FITTING 705255", "code_information": [{"code": "705255", "type": "CDM"}], "standard_charges": [{"gross_charge": 1722.0, "discounted_cash": 464.94, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED FOR 4.5 MM CANNULATED SCREW", "code_information": [{"code": "311.59", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1633.29, "discounted_cash": 440.99, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP CANNULATED FPR 4 MM CANNULATED SCREW", "code_information": [{"code": "311.63", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1382.3, "discounted_cash": 373.22, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP DRILL 2.8MM", "code_information": [{"code": "HR-D105", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.6, "discounted_cash": 58.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP DRILL 5.5 1100029-55", "code_information": [{"code": "1100029-55", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1485.0, "discounted_cash": 400.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCREW 110 MM TAP DEPTH FOR 4.5 MM CORTEX AND SHAFT SCREW", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "311.48", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 475.95, "discounted_cash": 128.51, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCREW 50MM 20MM USABLE FOR CORTEX SCREWS 1.5 MM DIAMETERINSTR", "code_information": [{"code": "311.15", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 371.45, "discounted_cash": 100.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCREW 53MM 23MM USABLE FOR CORTEX SCREWS 2 MM DIAMETERINSTR", "code_information": [{"code": "311.19", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 68.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TAP SCREW 57 MM TAP DEPTH FOR 4.5 MM CORTEX SHAFT SCREW", "code_information": [{"code": "311.46", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 432.82, "discounted_cash": 116.86, "setting": "both", "billing_class": "facility"}]}, {"description": 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TO CORRECT COLOR 6.1 TO 20.0 SQ CM 11921", "code_information": [{"code": "11921", "type": "CPT"}, {"code": "9549521", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 4437.0, "discounted_cash": 1197.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 3327.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TB AG RESPONSE T-CELL SUSP", "code_information": [{"code": "86481", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 55.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBP GENE DETC ABNOR ALLELES", "code_information": [{"code": "81344", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 123.3, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS DXA CAL W/I&R FX RISK", "code_information": [{"code": "77089", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 43.46, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TBS I&R FX RSK QHP", "code_information": [{"code": "77092", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 10.42, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT IMPL WRLS P-ART PRS SNR", "code_information": [{"code": "33289", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 33820.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 33820.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT IMPLTJ C SINS RDCTJ DEV", "code_information": [{"code": "645T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 9621.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 9621.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 6016.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 1CHMBR LDLS PM RA", "code_information": [{"code": "823T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM CMPL", "code_information": [{"code": "795T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RA", "code_information": [{"code": "796T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INS 2CHMBR LDLS PM RV", "code_information": [{"code": "797T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INSJ/RPL PERM LDLS PM", "code_information": [{"code": "33274", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 22671.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 22671.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT INTRA-C NFS SUPERSAT O2", "code_information": [{"code": "659T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT L VENTR RSTRJ DEV IMPLT", "code_information": [{"code": "643T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT MV ANNULUS RCNSTJ", "code_information": [{"code": "544T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT PLMT&RMVL CEPD PERQ", "code_information": [{"code": "33370", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"standard_charges": [{"minimum": 450.0, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV 2CHMBR LDLS PM CMPL", "code_information": [{"code": "798T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL 2CHMBR LDLS PM", "code_information": [{"code": "801T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL1CHMB LDLS PM RA", "code_information": [{"code": "825T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RA", "code_information": [{"code": "802T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMV&RPL2CHMB LDLS PM RV", "code_information": [{"code": "803T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RA", "code_information": [{"code": "799T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL 2CHMBR LDLS PM RV", "code_information": [{"code": "800T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL PERM LDLS PM W/IMG", "code_information": [{"code": "33275", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT RMVL/DBLK ICAR MAS PERQ", "code_information": [{"code": "644T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL OPN", "code_information": [{"code": "806T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TCAT S&IVC PRSTC VL IMPL PRQ", "code_information": [{"code": "805T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY DIAGNOSTIC", "code_information": [{"code": "32601", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", 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{"description": "THORACOSCOPY FOR LVRS", "code_information": [{"code": "32672", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY LYMPH NODE EXC", "code_information": [{"code": "32674", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found 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"methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOV FB/FIBRIN", "code_information": [{"code": "32653", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE CORTEX", "code_information": [{"code": "32651", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY REMOVE SEGMENT", "code_information": [{"code": "32669", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY RESECT BULLAE", "code_information": [{"code": "32655", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7287.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/ TH NRV EXC", "code_information": [{"code": "32664", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX MED SPACE", "code_information": [{"code": "32606", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX NODULE", "code_information": [{"code": "32608", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/BX PLEURA", "code_information": [{"code": "32609", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, 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{"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/PLEURECTOMY", "code_information": [{"code": "32656", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/W RESECT DIAG", "code_information": [{"code": "32668", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY W/WEDGE RESECT", "code_information": [{"code": "32666", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSCOPY WBX SAC", "code_information": [{"code": "32604", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/FLAP DRAINAGE", "code_information": [{"code": "32036", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THORACOSTOMY W/RIB RESECTION", "code_information": [{"code": "32035", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THREADED PLATE BENDERS 7001-BEND", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "7001-BEND", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 172.5, "discounted_cash": 46.58, "setting": "both", "billing_class": "facility"}]}, {"description": "THREADED SCREW SET", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "SS-219", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "THRMBC/NFS 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36905", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 8300.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THRMBC/NFS DIALYSIS CIRCUIT", "code_information": [{"code": "36906", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 22671.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 22671.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROAT MUSCLE SURGERY", "code_information": [{"code": "43030", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBIN TIME PLASMA", "code_information": [{"code": "85670", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA 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{"description": "THROMBIN TOPICAL 5,000 IU/5ML", "code_information": [{"code": "MED0201", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 148.76, "discounted_cash": 40.17, "setting": "both", "billing_class": "facility"}]}, {"description": "THROMBLYTIC ART/VEN THERAPY", "code_information": [{"code": "37213", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOLYTIC THERAPY STROKE", "code_information": [{"code": "37195", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THROMBOMODULIN", "code_information": [{"code": "85337", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 31.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THXP APHERESIS W/HDL DELIP", "code_information": [{"code": "342T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "THYROGLOBULIN ANTIBODY", "code_information": [{"code": "86800", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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{"description": "TIP PHACO .9MM 45DEG KELMAN MINI ANGLED REPROCESS STRL DISP", "code_information": [{"code": "8065750853R", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 81.32, "discounted_cash": 21.96, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP PHACO 19GA 15DEG LAMINAR", "code_information": [{"code": "OPOR1519L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 255.0, "discounted_cash": 68.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP PHACO 30DEG LAMINAR FLOW", "code_information": [{"code": "OPOR3020L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 268.6, "discounted_cash": 72.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCT YANKAUER STANDARD BULB OPERATING ROOM WITHOUT CONTROL VNT LF STRL", "code_information": [{"code": "DYND50130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION 18FR SIGMOID PLN", "code_information": [{"code": "166030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.98, "discounted_cash": 1.88, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION YANKAUER FLANGE TIP RIGID WITHOUT VNT LF STRL", "code_information": [{"code": "DYND50140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP SUCTION YANKAUER STANDARD WITHOUT CONTROL VENT", "code_information": [{"code": "34870", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.13, "discounted_cash": 1.39, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP TAMP CONICAL REPLACE MAGNUM", "code_information": [{"code": "31-158931", "type": "CDM"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 40.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP TAMP FLAT REPLACE MAGNUM", "code_information": [{"code": "31-158932", "type": "CDM"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 44.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP WASHER 14MM SPIKEDINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "221014", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1239.0, "discounted_cash": 334.53, "setting": "both", "billing_class": "facility"}]}, {"description": "TIP WASHER 17MM SPIKEDINSTR", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "221017", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1326.0, "discounted_cash": 358.02, "setting": "both", "billing_class": "facility"}]}, {"description": "TIPS PIPETTE  UNI 200UL LOW-RETENTION RACKED DLS151150R-96", "code_information": [{"code": "DLS151150R-96", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 0.81, "setting": "both", "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL 1ST SHNT", "code_information": [{"code": "33745", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7786.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TIS CGEN CAR ANOMAL EA ADDL", "code_information": [{"code": "33746", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7786.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EX MOLECUL STUDY ADD-ON", "code_information": [{"code": "88388", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 12.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS EXAM MOLECULAR STUDY", "code_information": [{"code": "88387", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 7.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT NONRESORB", "code_information": [{"code": "D7957", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISS REGEN EDENT 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2ML", "code_information": [{"code": "MED0203", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 487.97, "discounted_cash": 131.75, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSEEL 4ML", "code_information": [{"code": "MED0204", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 517.92, "discounted_cash": 139.84, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSEEL PRE-FILLED PRIMA SYRINGE 2ML 1506078", "code_information": [{"code": "C9250", "type": "HCPCS"}, {"code": "1506078", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 268.74, "discounted_cash": 72.56, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE ADHESIVE 1.0ML EXOFIN SKIN AFFIX APPLICATORS", "code_information": [{"code": "M1205", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 58.5, "discounted_cash": 15.8, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE AUTOGRAFT FACE/GENITALIA/HANDS/FEET  ADDITIONAL 1 SQ/CM TO 75 SQ/CM 15156", "code_information": [{"code": "15156", "type": "CPT"}, {"code": "1482239", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 7125.0, "gross_charge": 9500.0, "discounted_cash": 2565.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 7125.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE AUTOGRAFT FACE/GENITALIA/HANDS/FEET 1ST 25 SQ/CM OR LESS 15155", "code_information": [{"code": "15155", "type": "CPT"}, {"code": "1482240", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 8250.0, "gross_charge": 11000.0, "discounted_cash": 2970.0, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 8250.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE BONE MARROW", "code_information": [{"code": "88237", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 129.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE LYMPHOCYTE", "code_information": [{"code": "88230", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 104.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE PLACENTA", "code_information": [{"code": "88235", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 135.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE SKIN/BIOPSY", "code_information": [{"code": "88233", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 126.66, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE CULTURE TUMOR", "code_information": [{"code": "88239", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 132.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXAM FOR FUNGI", "code_information": [{"code": "87220", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3.84, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE EXTRACTOR BRUSH  BENT POWER 315-0025", "code_information": [{"code": "315-0025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 212.5, "discounted_cash": 57.38, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE GRAFTS-OTHER (EG.  PARATENON/ FAT/DERMIS) 20926", "code_information": [{"code": "20926", "type": "CPT"}, {"code": "1482245", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 3711.0, "discounted_cash": 1001.97, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE HOMOGENIZATION CULTR", "code_information": [{"code": "87176", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE LYOPRESERVED UMBILICAL  2 X 4 CM PS61024", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "PS61024", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5010.0, "discounted_cash": 1352.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE NXT  HELIX PRO 6PK NXT-THXP-130", "code_information": [{"code": "NXT-THXP-130", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 876.71, "discounted_cash": 236.71, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE REGEN NON-RESORBABLE", "code_information": [{"code": "D6107", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE REGEN RESORBABLE", "code_information": [{"code": "D6106", "type": "HCPCS"}], "standard_charges": [{"minimum": 1862.0, "maximum": 1862.0, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TISSUE RELEASE SMARTRELEASE ENDOSCOPIC SOFT  83030", "code_information": [{"code": "83030", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 880.0, "discounted_cash": 237.6, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE RMVL DEVICE 4MM X 32CM MYOSURE XL MYOMCMY", "code_information": [{"code": "50-501XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3136.74, "discounted_cash": 846.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE RMVL DEVICE MYOSURE XL MYOMCMY", "code_information": [{"code": "50-503XL", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3136.74, "discounted_cash": 846.92, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE SEALER ENSEAL X1 CURVED 37CM SHAFT   NSLX137C", "code_information": [{"code": "NSLX137C", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1563.18, "discounted_cash": 422.06, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE SEGMENT FIBULA 15CM FD ASP", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "92-0047", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2088.0, "discounted_cash": 563.76, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE TENDENT", "code_information": [{"code": "Q4133", "type": "HCPCS"}, {"code": "PS60005", "type": "CDM"}, {"code": "636", "type": "RC"}], "standard_charges": [{"gross_charge": 5469.75, "discounted_cash": 1476.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE THERAGENESIS BI-LAYER 8.2CM X 12CM 98.4 SQ CM NON-MESHED TG-B82120", "code_information": [{"code": "A2008", "type": "HCPCS"}, {"code": "TG-B82120", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7388.07, "discounted_cash": 1994.78, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUE THERAGENESIS BI-LAYER 8.2CM X 6CM 49.2 SQ CM NON-MESHED TG-B8260", "code_information": [{"code": "Q4122", "type": "HCPCS"}, {"code": "TG-B8260", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5910.45, "discounted_cash": 1595.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TISSUES ACHILLES TENDON WITH CALC 430200", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "430200", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5355.0, "discounted_cash": 1445.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TITANIUM ALLERGY DISC", "code_information": [{"code": "2007-4-212", "type": "CDM"}], "standard_charges": [{"gross_charge": 79.8, "discounted_cash": 21.55, "setting": "both", "billing_class": "facility"}]}, {"description": "TLH UTERUS 250 G OR LESS", "code_information": [{"code": "58570", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O 250 G OR LESS", "code_information": [{"code": "58571", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TLH W/T/O UTERUS OVER 250 G", "code_information": [{"code": "58573", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TM REVERSE 36MM POLY LINER +6MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "-4349-036-06", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2550.0, "discounted_cash": 688.5, "setting": "both", "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DEBRIDEMENT", "code_information": [{"code": "D7877", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISC REPOSIT", "code_information": [{"code": "D7874", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY DISCECTOMY", "code_information": [{"code": "D7876", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY LYSIS ADHESN", "code_information": [{"code": "D7873", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ARTHROSCOPY SYNOVECTOMY", "code_information": [{"code": "D7875", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ ASPIRATION JOINT FLUID", "code_information": [{"code": "D7870", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING INTO JOINT", "code_information": [{"code": "D7860", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ CUTTING OF A MUSCLE", "code_information": [{"code": "D7856", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ DIAGNOSTIC ARTHROSCOPY", "code_information": [{"code": "D7872", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ EXCISN OF JOINT MEMBRANE", "code_information": [{"code": "D7854", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ MANIPULATION UNDER ANEST", "code_information": [{"code": "D7830", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ MENISCECTOMY", "code_information": [{"code": "D7850", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ OPEN REDUCT-DISLOCATION", "code_information": [{"code": "D7810", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ RECONSTRUCTION", "code_information": [{"code": "D7858", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ REPAIR OF JOINT DISC", "code_information": [{"code": "D7852", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMJ RESHAPING COMPONENTS", "code_information": [{"code": "D7865", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMPST AUTO TUBE DLVR SYS", "code_information": [{"code": "583T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMVI PERCUTANEOUS APPROACH", "code_information": [{"code": "483T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TMVI TRANSTHORACIC EXPOSURE", "code_information": [{"code": "484T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOBOA; TRAY OPTETRAK SZ 4F/4T", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "2-012-45-4040", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 3600.0, "discounted_cash": 972.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRADEX 0.1%-0.3% OPTH OINT 3.5GM", "code_information": [{"code": "MED0209", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 633.78, "discounted_cash": 171.12, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRADEX OPTH 0.1%-0.3% SUSP 2.5 ML", "code_information": [{"code": "MED0208", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 138.52, "discounted_cash": 37.4, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN (TOBREX) 0.3% OPHTH DROPS 5ML", "code_information": [{"code": "MED0207", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 47.52, "discounted_cash": 12.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 1.2 gm POWDER", "code_information": [{"code": "MED0206", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 217.87, "discounted_cash": 58.82, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 40MG", "code_information": [{"code": "MED0374", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 10.22, "discounted_cash": 2.76, "setting": "both", "billing_class": "facility"}]}, {"description": "TOBRAMYCIN 80 MG / 2 ML VIAL", "code_information": [{"code": "MED0375", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 1.35, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE JOINT MPJ 2ND - 5TH 16870", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "16870", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 5685.0, "discounted_cash": 1534.95, "setting": "both", "billing_class": "facility"}]}, {"description": "TOE JOINT TRANSFER", "code_information": [{"code": "26556", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOE TAC MEDIUM HAMMERTOE FIXATION SYSTEM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "HT-00002", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4776.0, "discounted_cash": 1289.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TOME GUIDE (MANDATORY)", "code_information": [{"code": "200064", "type": "CDM"}], "standard_charges": [{"gross_charge": 1047.0, "discounted_cash": 282.69, "setting": "both", "billing_class": "facility"}]}, {"description": "TOMOSYNTHESIS, MAMMO", "code_information": [{"code": "G0279", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.86, "maximum": 25.86, "setting": "outpatient", "payers_information": [{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 25.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONE DECAY HEARING TEST", "code_information": [{"code": "92563", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE AND NECK SURGERY", "code_information": [{"code": "41135", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE BASE VOL REDUCTION", "code_information": [{"code": "41530", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 9529.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 9529.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE JAW & NECK SURGERY", "code_information": [{"code": "41155", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE MOUTH JAW SURGERY", "code_information": [{"code": "41150", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE REMOVAL NECK SURGERY", "code_information": [{"code": "41145", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE SUSPENSION", "code_information": [{"code": "41512", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TONGUE TO LIP SURGERY", "code_information": [{"code": "41510", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOOL ASSEMBLY 50MM TAPER DIST FASTENER ARCOS", "code_information": [{"code": "31-302005", "type": "CDM"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 344.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL ASSEMBLY 60MM TAPER DIST FASTENER ARCOS", "code_information": [{"code": "31-302006", "type": "CDM"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 344.25, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL ASSEMBLY 70MM TAPER DIST FASTENER ARCOS", "code_information": [{"code": "31-302007", "type": "CDM"}], "standard_charges": [{"gross_charge": 1275.0, "discounted_cash": 344.25, 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"discounted_cash": 300.51, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL PLATE REMOVAL MAGNUM HANDLE ADAPTER REGENEREX", "code_information": [{"code": "S313135", "type": "CDM"}], "standard_charges": [{"gross_charge": 1455.0, "discounted_cash": 392.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL 20 LINER RINGLOC", "code_information": [{"code": "31-424207", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL 21-28 LINER RINGLOC", "code_information": [{"code": "31-424206", "type": "CDM"}], "standard_charges": [{"gross_charge": 1800.0, "discounted_cash": 486.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL 36MM SZ 24 TRIPOLAR", "code_information": [{"code": "31-165300", "type": "CDM"}], "standard_charges": [{"gross_charge": 2400.0, "discounted_cash": 648.0, "setting": "both", 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{"description": "TOOL REMOVAL 46MM TO 47MM BIPOLAR RINGLOC", "code_information": [{"code": "31-165316", "type": "CDM"}], "standard_charges": [{"gross_charge": 1152.0, "discounted_cash": 311.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL 48MM TO 50MM BIPOLAR RINGLOC", "code_information": [{"code": "31-165320", "type": "CDM"}], "standard_charges": [{"gross_charge": 1152.0, "discounted_cash": 311.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL 51MM TO 52MM BIPOLAR RINGLOC", "code_information": [{"code": "31-165326", "type": "CDM"}], "standard_charges": [{"gross_charge": 1152.0, "discounted_cash": 311.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL 53MM TO 55MM BIPOLAR RINGLOC", "code_information": [{"code": "31-165330", "type": "CDM"}], "standard_charges": [{"gross_charge": 1152.0, "discounted_cash": 311.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL 58MM TO 61MM BIPOLAR RINGLOC", "code_information": [{"code": "31-165340", "type": "CDM"}], "standard_charges": [{"gross_charge": 1152.0, "discounted_cash": 311.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL TAPERINSERT MAGNUM", "code_information": [{"code": "31-139250", "type": "CDM"}], "standard_charges": [{"gross_charge": 7158.0, "discounted_cash": 1932.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL REMOVAL UNIVERSAL TIBL TRIAL VANGUARD", "code_information": [{"code": "32-483896", "type": "CDM"}], "standard_charges": [{"gross_charge": 2970.0, "discounted_cash": 801.9, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL RULER 6IN COMPRESS", "code_information": [{"code": "32-481155", "type": "CDM"}], "standard_charges": [{"gross_charge": 360.0, "discounted_cash": 97.2, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TIBL OFFSET TRIAL", "code_information": [{"code": "32-341532", "type": "CDM"}], "standard_charges": [{"gross_charge": 3181.75, "discounted_cash": 859.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TRAPEZIECTOMY DISP", "code_information": [{"code": "AR-8919-01", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 391.0, "discounted_cash": 105.57, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TRAPEZIECTOMY STERILE", "code_information": [{"code": "AR-8919-01S", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 894.3, "discounted_cash": 241.46, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TUNNELING 20\" 1120", "code_information": [{"code": "1120", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 127.65, "discounted_cash": 34.47, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TUNNELING 35 CM LNG STRAW FOR PRECISION SPINAL CORD SIMULATOR SYSS", "code_information": [{"code": "SC-4254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 363.8, "discounted_cash": 98.23, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL TUNNELING 38CM/60CM ACCESSORY KIT", "code_information": [{"code": "365560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 476.0, "discounted_cash": 128.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOL WRENCH FOR TAPER BREAKER OSS", "code_information": [{"code": "32-481161", "type": "CDM"}], "standard_charges": [{"gross_charge": 3156.0, "discounted_cash": 852.12, "setting": "both", "billing_class": "facility"}]}, {"description": "TOOTH REIMPLANTATION", "code_information": [{"code": "D7270", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"discounted_cash": 2630.07, "setting": "both", "billing_class": "facility"}]}, {"description": "TOP TIBL EXTRAMEDULLARY VANGUARD PREMIER", "code_information": [{"code": "32-487551", "type": "CDM"}], "standard_charges": [{"gross_charge": 13200.0, "discounted_cash": 3564.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOP TIBL OVER THE TOP PREMIER", "code_information": [{"code": "32-487552", "type": "CDM"}], "standard_charges": [{"gross_charge": 7656.0, "discounted_cash": 2067.12, "setting": "both", "billing_class": "facility"}]}, {"description": "TORPEDO CURVED 4MM", "code_information": [{"code": "AR-8400CTD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 343.4, "discounted_cash": 92.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TORPEDO CURVED HL 4.2MM X 19CM  AR-6420CTD", "code_information": [{"code": "AR-6420CTD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 343.4, "discounted_cash": 92.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TORPEDO SYSTEM", "code_information": [{"code": "AR-6420TD", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 343.4, "discounted_cash": 92.72, "setting": "both", "billing_class": "facility"}]}, {"description": "TORQUE CENTER SNGL CLAW", "code_information": [{"code": "13-104060", "type": "CDM"}], "standard_charges": [{"gross_charge": 7707.0, "discounted_cash": 2080.89, "setting": "both", "billing_class": "facility"}]}, {"description": "TOT DISC ARTHRP 1NTRSPC LMBR", "code_information": [{"code": "22857", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 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"standard_charges": [{"gross_charge": 510.0, "discounted_cash": 137.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TOT TOE METATARSAL TRIAL SMALL", "code_information": [{"code": "407131", "type": "CDM"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 137.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TOT TOE METATARSAL TRIAL XSM", "code_information": [{"code": "407130", "type": "CDM"}], "standard_charges": [{"gross_charge": 510.0, "discounted_cash": 137.7, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL ABDOMINAL HYSTERECTOMY W/ OR W/O REML OF TUBE(S) OR OVARY(S) 58150", "code_information": [{"code": "58150", "type": "CPT"}, {"code": "1482250", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 10384.5, "gross_charge": 13846.0, "discounted_cash": 3738.42, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 10384.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED 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[{"gross_charge": 689.97, "discounted_cash": 186.29, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL DISC ARTHROPLASTY CERVICAL ANTERIOR APPROACH; SINGLE INTERSPACE 22856", "code_information": [{"code": "22856", "type": "CPT"}, {"code": "1482253<and>1482253", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "gross_charge": 8637.0, "discounted_cash": 2331.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 6477.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HIP RESURFACING", "code_information": [{"code": "S2118", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL HYSTERECTOMY", "code_information": [{"code": "58152", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 8814.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TOTAL KNEE CAP", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "CAPMEDACTATOTALKNEE", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 11700.0, "discounted_cash": 3159.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TOTAL KNEE PACK 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"plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"billing_class": "facility"}]}, {"description": "TOTAL SHOULDER REPLACEMENT 23472", "code_information": [{"code": "23472", "type": "CPT"}, {"code": "1482256", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 8300.0, "gross_charge": 8637.0, "discounted_cash": 2331.99, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TR RETINAL LES PRETERM 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRABECULOPLASTY LASER SURG", "code_information": [{"code": "65855", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRACHEO-ESOPHAGOPLASTY CONG", "code_information": [{"code": "43314", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATH MTRAL VLVE REPAIR", 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"standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCATHETER BIOPSY", "code_information": [{"code": "37200", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCOCHLEAR APPROACH/SKULL", "code_information": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCRV ABLTJ UTRN FIBRD 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS CARBOXYHB", "code_information": [{"code": "88740", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 8.43, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSCUTANEOUS METHB", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF HEART", "code_information": [{"code": 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF LIVER", "code_information": [{"code": "47135", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"description": "TRANSPLANTATION OF MULTIVISC", "code_information": [{"code": "S2054", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTATION OF SMALL INT", "code_information": [{"code": "S2053", "type": "HCPCS"}], "standard_charges": [{"minimum": 3683.0, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLANTS OF THIGH TENDONS", "code_information": [{"code": "27397", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSPLJ HEMATOPOIETIC BOOST", "code_information": [{"code": "38243", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSRECTAL DRAINAGE OF PELVIC ABSCESS 45000", "code_information": [{"code": "45000", "type": "CPT"}, {"code": "46463126", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 7163.0, "discounted_cash": 1934.01, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 5372.25, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRANSTHOR DIAPHRAG HERN RPR", "code_information": [{"code": "43334", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT CRANIOFACIAL FRACTURE", "code_information": [{"code": "21431", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FINGER FRACTURE EACH", "code_information": [{"code": "26740", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28570", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28576", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FOOT DISLOCATION", "code_information": [{"code": "28600", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25500", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT FRACTURE OF RADIUS", "code_information": [{"code": "25526", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27252", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27256", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27257", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP DISLOCATION", "code_information": [{"code": "27259", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HIP WALL FRACTURE", "code_information": [{"code": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT HUMERUS FRACTURE", "code_information": [{"code": "24560", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27556", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEE DISLOCATION", "code_information": [{"code": "27558", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP DISLOCATION", "code_information": [{"code": "27560", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNEECAP FRACTURE", 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT KNUCKLE DISLOCATION", "code_information": [{"code": "26700", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21452", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK 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"HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21465", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER JAW FRACTURE", "code_information": [{"code": "21470", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7577.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 7577.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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"standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT LOWER LEG DISLOCATION", "code_information": [{"code": "27832", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MIDFOOT FRACTURE", "code_information": [{"code": "28456", "type": "CPT"}], "standard_charges": 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT MOUTH ROOF FRACTURE", "code_information": [{"code": "21421", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee 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5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/GRAFT", "code_information": [{"code": "22319", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT ODONTOID FX W/O GRAFT", "code_information": [{"code": "22318", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT PENIS LESION GRAFT", "code_information": [{"code": "54112", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SKULL FRACTURE", "code_information": [{"code": "62005", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee 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"standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT SPINE FRACTURE", "code_information": [{"code": "22325", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7879.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7879.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4928.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT STERNUM FRACTURE", "code_information": [{"code": "21825", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TAIL BONE FRACTURE", "code_information": [{"code": "27202", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6631.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT THIGH FX GROWTH PLATE", "code_information": [{"code": "27519", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], 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{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT TRIGEMINAL TRACT", "code_information": [{"code": "61791", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT UTERUS INFECTION", "code_information": [{"code": "59830", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT VAGINA INFECTION", "code_information": [{"code": "57150", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST BONE FRACTURE", "code_information": [{"code": "25630", "type": "CPT"}], 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"fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT WRIST FRACTURE", "code_information": [{"code": "25680", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": 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"standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREAT/GRAFT HEEL FRACTURE", "code_information": [{"code": "28420", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 6768.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 6768.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4192.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 6553.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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"standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF ANKLE FRACTURE", "code_information": [{"code": "28435", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 4474.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF BONE CYST", "code_information": [{"code": "20615", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 11568.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF 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"standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RECTAL PROLAPSE", "code_information": [{"code": "45520", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee 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historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TREATMENT OF RETINAL LESION", "code_information": [{"code": "67210", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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[{"gross_charge": 4500.0, "discounted_cash": 1215.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRINITY ELITE LARGE", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410003", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7800.0, "discounted_cash": 2106.0, "setting": "both", "billing_class": "facility"}]}, {"description": "TRINITY ELITE SMALL", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "410001", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1068.0, "discounted_cash": 288.36, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPLE-EDGE RELEASE INSTRUMENT SN21", "code_information": [{"code": "SN21", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1155.0, "discounted_cash": 311.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRIPLE-STITCH ENDOSTITCH SINGLE USE 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "TRLUML BALO ANGIOP 1ST 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76.5, "discounted_cash": 20.66, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO XCEL BLADELESS 15MM 100MM B15LT", "code_information": [{"code": "B15LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 461.98, "discounted_cash": 124.73, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDO XCEL BLDLS 11MM STRL NO HNDL B11LT", "code_information": [{"code": "B11LT", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 87.11, "discounted_cash": 23.52, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDOPATH XCEL BLADELESS 11MM B11LP", "code_information": [{"code": "B11LP", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 557.35, "discounted_cash": 150.48, "setting": "both", "billing_class": "facility"}]}, {"description": "TROCAR ENDOSCOPY 5 X 75MM ENDOPATH EXCEL OPTIVIEW BLADELESS REPROCESSED 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[{"code": "31-162404", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUNNION PROVISIONAL 7 TO 10 LAT ECHO FPP", "code_information": [{"code": "31-162398", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUNNION PROVISIONAL 7 TO 10 STANDARD ECHO", "code_information": [{"code": "31-162413", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRUNNION PROVISIONAL 7 TO 10 STANDARD ECHO FPP", "code_information": [{"code": "31-162395", "type": "CDM"}], "standard_charges": [{"gross_charge": 2955.0, "discounted_cash": 797.85, "setting": "both", "billing_class": "facility"}]}, {"description": "TRURL ABLTJ MAL PRST8 TISS", "code_information": [{"code": "582T", "type": "CPT"}], "standard_charges": [{"minimum": 450.0, "maximum": 4876.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 4876.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3021.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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{"description": "TUBE 4.0MM ENDOTRACHEAL NASAL UNCUFF PREFORMED", "code_information": [{"code": "5-22108", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.19, "discounted_cash": 6.26, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 4.5MM ENDOTRACHEAL NASAL UNCUFF PREFORMED", "code_information": [{"code": "5-22109", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 23.19, "discounted_cash": 6.26, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 4.5MM ENDOTRACHEAL ORAL CUFF PREFORMED", "code_information": [{"code": "5-22209", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 43.82, "discounted_cash": 11.83, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE 4.5MM TRACH MURPHY", "code_information": [{"code": "86237", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.93, 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"code_information": [{"code": "111781035", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.09, "discounted_cash": 7.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3.5MM NASAL ORAL UNCUFFED MURPHY EYE W/ TIP TO TIP RADIOPAQUE LINE LF", "code_information": [{"code": "86224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.16, "discounted_cash": 1.39, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 3MM CLR MAGILL ORAL NASAL UNCFFD LF STRL DISP", "code_information": [{"code": "86462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.66, "discounted_cash": 1.53, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.0MM INTERMEDIATE HI-LO CUFFED", "code_information": [{"code": "86444", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.85, "discounted_cash": 2.12, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM CUFFED NASAL RAE LF", "code_information": [{"code": "111781045", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 26.09, "discounted_cash": 7.04, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM MURPHY LO PRO", "code_information": [{"code": "86046", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.6, "discounted_cash": 2.05, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM NASAL RAE MURPHY HOODED 2 EYE UNCFFD LF STRL", "code_information": [{"code": "86286", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 49.78, "discounted_cash": 13.44, "setting": "both", "billing_class": "facility"}]}, {"description": "TUBE ENDO 4.5MM RAY MURPHY ORAL PREFORMED CUFFED", "code_information": [{"code": "86199", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX RENAL", "code_information": [{"code": "50549", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX SPLEEN", "code_information": [{"code": "38129", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA 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"AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED LAPS PX URETER", "code_information": [{"code": "50949", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAAA", "code_information": [{"code": "81599", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MAXLFCL PROSTH PX", "code_information": [{"code": "21089", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MICROBIOLOGY PX", "code_information": [{"code": "87999", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PATH TEST", "code_information": [{"code": "89240", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 44.78, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MISC PX DX NUC MED", "code_information": [{"code": "78999", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MOLECULAR PATHOLOGY", "code_information": [{"code": "81479", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED MUSCSKEL PX HEAD", "code_information": [{"code": "21499", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX DIAPHRAGM", "code_information": [{"code": "39599", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": 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"methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2291.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 2610.0, 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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"standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX LACRIMAL SYSTEM", "code_information": [{"code": "68899", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX MED RADJ PHYSICS", "code_information": [{"code": "77399", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX POSTERIOR SEGMNT", "code_information": [{"code": "67299", "type": "CPT"}], 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "UNLISTED PX TEMPORAL BONE", "code_information": [{"code": 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"standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 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"standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US NRV&ACC STRUX 1XTR COMPRE", "code_information": [{"code": "76883", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Pelvis Non-OB Complete 76856", "code_information": [{"code": "76856", "type": "CPT"}, {"code": "630929", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 710.0, "discounted_cash": 191.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", 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"discounted_cash": 191.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 93.77, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 394.76, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Pregnancy 1st Trimester 76801", "code_information": [{"code": "76801", "type": "CPT"}, {"code": "630921", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 710.0, "discounted_cash": 191.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 116.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 394.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "US Pregnancy After 1st Trimester 76805", "code_information": [{"code": "76805", "type": "CPT"}, {"code": "630919", "type": "CDM"}, {"code": "402", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 710.0, "discounted_cash": 191.7, "setting": "both", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 141.58, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 394.76, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", 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"plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VAG HYST INCL T/O COMPLEX", "code_information": [{"code": "58291", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 7411.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA 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{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "standard_charge_dollar": 5625.75, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3106.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VBAC CARE AFTER DELIVERY", "code_information": [{"code": "59614", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 2726.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", 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"standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN BYP FEM-TIBIAL PERONEAL", "code_information": [{"code": "35585", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH 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{"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY ARM/LEG", "code_information": [{"code": "75820", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 125.46, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1577.12, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER", "code_information": [{"code": "75891", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 251.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75885", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 251.67, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/HEMODYNAM", "code_information": [{"code": "75889", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 251.12, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY LIVER W/O HEMODYN", "code_information": [{"code": "75887", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 255.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEIN X-RAY SPLEEN/LIVER", "code_information": [{"code": "75810", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 95.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3157.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R CERVICAL", "code_information": [{"code": "92517", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TEST I&R OCULAR", "code_information": [{"code": "92518", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEMP TST I&R CERVICAL&OCULAR", "code_information": [{"code": "92519", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN MECHNL THRMBC REPEAT TX", "code_information": [{"code": "37188", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 12453.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 3354.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 3822.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VEN THROMBOSIS IMAGES BILAT", "code_information": [{"code": "78458", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 225.92, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 149.21, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 412.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN 1 YR/>", "code_information": [{"code": "36425", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE CUTDOWN < 1 YR", "code_information": [{"code": "36420", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 695.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENIPUNCTURE; AGE 3 AND OLDER REQUIRING A PHYSICIAN 36410", "code_information": [{"code": "36410", "type": "CPT"}, {"code": "42909063", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "gross_charge": 520.0, "discounted_cash": 140.4, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS MECH THROMBECTOMY", "code_information": [{"code": "37187", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 12453.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 7786.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5821.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 6631.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS SAMPLING BY CATHETER", "code_information": [{"code": "75893", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 249.99, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 5448.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VENOUS THROMBOSIS IMAGING", "code_information": [{"code": "78457", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": 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"VERSA-DIAL 46X24X47MM HEAD PROV", "code_information": [{"code": "407246", "type": "CDM"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL 46X27X46MM HEAD PROV", "code_information": [{"code": "407248", "type": "CDM"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL 50X24X52MM HEAD PROV", "code_information": [{"code": "407256", "type": "CDM"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL 50X27X50MM HEAD PROV", "code_information": [{"code": "407258", "type": "CDM"}], "standard_charges": [{"gross_charge": 1500.0, "discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL 54X21X64MM HEAD PROV", "code_information": [{"code": "407264", 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"discounted_cash": 405.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL COMPR ADAPTOR PROV", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "407201", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1041.0, "discounted_cash": 281.07, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL HEAD IMPACTOR", "code_information": [{"code": "407297", "type": "CDM"}], "standard_charges": [{"gross_charge": 2916.0, "discounted_cash": 787.32, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL HEAD SIZER PLATE", "code_information": [{"code": "407293", "type": "CDM"}], "standard_charges": [{"gross_charge": 900.0, "discounted_cash": 243.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL HEAD TRIAL SCREWDRIVER", "code_information": [{"code": "407296", "type": "CDM"}], "standard_charges": [{"gross_charge": 1347.0, "discounted_cash": 363.69, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL HEAD/ADAPT IMPACTOR", "code_information": [{"code": "407299", "type": "CDM"}], "standard_charges": [{"gross_charge": 14400.0, "discounted_cash": 3888.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL HEAD/ADAPT SEPARATOR", "code_information": [{"code": "407298", "type": "CDM"}], "standard_charges": [{"gross_charge": 2388.0, "discounted_cash": 644.76, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSA-DIAL TAPER IMPACT BASE", "code_information": [{"code": "407281", "type": "CDM"}], "standard_charges": [{"gross_charge": 1221.0, "discounted_cash": 329.67, "setting": "both", "billing_class": "facility"}]}, {"description": "VERSAFITCUP DM LINER HC 52/28 01.26.2852MHC", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "1.26.2852MHC", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2355.0, 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[{"code": "1292", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 10.88, "discounted_cash": 2.94, "setting": "both", "billing_class": "facility"}]}, {"description": "VIPER VENOM PROTHROMBIN TIME", "code_information": [{"code": "85612", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 15.74, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS ANTIBODY NOS", "code_information": [{"code": "86790", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", 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"methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 17.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIRUS INOCULATION TISSUE", "code_information": [{"code": "87252", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 23.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 1 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"percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 2 PROSTH", "code_information": [{"code": "34846", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 3 PROSTH", "code_information": [{"code": "34847", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISC & INFRAREN ABD 4+ PROST", "code_information": [{"code": "34848", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5946.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISCOAT 0.5 ML", "code_information": [{"code": "MED0217", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 454.54, "discounted_cash": 122.73, "setting": "both", "billing_class": "facility"}]}, {"description": "VISCOAT/HEALON ENDOCOAT 30MG/ML 0.85ML", "code_information": [{"code": "MED0526", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 459.99, "discounted_cash": 124.2, "setting": "both", "billing_class": "facility"}]}, {"description": "VISE GRIP EXTCR PLIERS", "code_information": [{"code": "474520", "type": "CDM"}], "standard_charges": [{"gross_charge": 4953.0, "discounted_cash": 1337.31, "setting": "both", "billing_class": "facility"}]}, {"description": "VISIGI 3D CALIBRATION SYSTEM STANDER HOL PATTERN W / BULB 36FR", "code_information": [{"code": "5236B", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 788.7, "discounted_cash": 212.95, "setting": "both", "billing_class": "facility"}]}, {"description": "VISUAL ACUITY SCREEN", "code_information": [{"code": "99173", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL AUDIOMETRY (VRA)", "code_information": [{"code": "92579", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUAL EP TEST CNS W/I&R", "code_information": [{"code": "95930", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VISUALIZATION OF WINDPIPE", "code_information": [{"code": "31615", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 3419.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee 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HMO/PPO/POS", "standard_charge_dollar": 1394.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1589.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT D 1 25-DIHYDROXY", "code_information": [{"code": "82652", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 34.65, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR HOLE", "code_information": [{"code": "67042", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MACULAR PUCKER", "code_information": [{"code": "67041", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 7411.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 4728.0, "methodology": "fee schedule"}, {"payer_name": 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{"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIT FOR MEMBRANE DISSECT", "code_information": [{"code": "67043", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 13461.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 8814.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 13461.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee 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"HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 4166.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 4743.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VITAL CARE C-ARM DRAPES 42X74 VAE5603", "code_information": [{"code": "VAE5603", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 11.27, "discounted_cash": 3.04, "setting": "both", "billing_class": "facility"}]}, {"description": "VITALLIUM ALLERGY DISC", "code_information": [{"code": "2007-4-211", "type": "CDM"}], "standard_charges": [{"gross_charge": 79.8, "discounted_cash": 21.55, "setting": "both", "billing_class": "facility"}]}, {"description": "VITAMIN D 25 HYDROXY", "code_information": [{"code": "82306", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 26.64, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VIVEX DBM PUTTY 1CC VX-EP1", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "VX-EP1", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1395.0, "discounted_cash": 376.65, "setting": "both", "billing_class": "facility"}]}, {"description": "VKORC1 GENE", "code_information": [{"code": "81355", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 79.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VLOC 180 ABS 2-0 CL 18 P-14 VLOCL0125", "code_information": [{"code": "VLOCL0125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 102.5, "discounted_cash": 27.68, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC 180 ABSORBABLE 2-0 ESTCH 4 LP VLOCA204L", "code_information": [{"code": "VLOCA204L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 254.15, "discounted_cash": 68.62, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC 180 ABSORBABLE 2-0 ESTCH 6 LP VLOCA206L", "code_information": [{"code": "VLOCA206L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 91.77, "discounted_cash": 24.78, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC ESTITCH NON ABS 0 8 LOOP VLOCN008L", "code_information": [{"code": "VLOCN008L", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 334.41, "discounted_cash": 90.29, "setting": "both", "billing_class": "facility"}]}, {"description": "VLOC SUTURE 180 ABS 2-0 GR 24 GS-21 VLOCL0335", "code_information": [{"code": "VLOCL0335", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.8, "discounted_cash": 31.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VLP MINI MOD 1.5 MM STRAIGHT PL 6H", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74441522", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1047.36, "discounted_cash": 282.79, "setting": "both", "billing_class": "facility"}]}, {"description": "VLP TI 1.5 MM X 12 MM CTX SCREW T4 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74401512", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.88, "discounted_cash": 37.23, "setting": "both", "billing_class": "facility"}]}, {"description": "VLP TI 1.5 MM X 13 MM CTX SCR T4 S-T", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "74401513", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 137.88, "discounted_cash": 37.23, "setting": "both", "billing_class": "facility"}]}, {"description": "VLVT PV CLSD HRT VIA P-ART", "code_information": [{"code": "33471", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1634.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC OPTIONS PPO", "standard_charge_dollar": 1862.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRD 360 REV FEM TRLS 55-62.5 CASE", "code_information": [{"code": "591320", "type": "CDM"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 3240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VNGRD 360 REV FEM TRLS 65-72.5 CASE", "code_information": [{"code": "591321", "type": "CDM"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 3240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VNGRD 360 REV FEM TRLS 75-80 CASE", "code_information": [{"code": "591322", "type": "CDM"}], "standard_charges": [{"gross_charge": 12000.0, "discounted_cash": 3240.0, "setting": "both", "billing_class": "facility"}]}, {"description": "VNGRPH CHD ANOM/PERSIST SVC", "code_information": [{"code": "93584", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", 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"additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD AZYGS/HEMIAZYGS", "code_information": [{"code": "93585", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH 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"standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HUMANA", "plan_name": "HUMANA PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 75.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "VNGRPH CHD CORONARY SINUS", "code_information": [{"code": "93586", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", 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19.98, "setting": "both", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 12.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Vasc emb/occ w/prs cath", "code_information": [{"code": "C9797", "type": "HCPCS"}], "standard_charges": [{"minimum": 450.0, "maximum": 8300.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 5946.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 3683.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 690.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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{"description": "WRIST SMALL RADIAL STEM LEFT TOTAL 8WR0-S00L-A", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "8WR0-S00L-A", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 2943.0, "discounted_cash": 794.61, "setting": "both", "billing_class": "facility"}]}, {"description": "WRLS SKN SNR ANISOTROPY MEAS", "code_information": [{"code": "639T", "type": "CPT"}], "standard_charges": [{"minimum": 86.57, "maximum": 3945.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 3945.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 2444.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 450.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1315.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1345.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 970.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1115.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 1810.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 855.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 605.0, "methodology": "fee schedule"}, {"payer_name": "HEALTH NET", "plan_name": "OKLAHOMA HEALTH NETWORK PPO", "standard_charge_dollar": 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[{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 822.6, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-LINKED INTELLECTUAL DBLT", "code_information": [{"code": "81471", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 822.6, "methodology": "fee schedule"}, {"payer_name": "UNITED 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"count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM ENTIRE SPI 6/> VW", "code_information": [{"code": "72084", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF BODY SECTION", "code_information": [{"code": "76100", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 113.24, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF FISTULA", "code_information": [{"code": "76080", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 50.97, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 533.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF JAW JOINT", "code_information": [{"code": "70332", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 81.55, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF KIDNEY LESION", "code_information": [{"code": "74470", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 44.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 533.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PENIS", "code_information": [{"code": "74445", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 95.62, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 113.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERINEUM", "code_information": [{"code": "74775", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 51.0, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF PERITONEUM", "code_information": [{"code": "74190", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 39.43, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 533.32, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF SALIVARY DUCT", "code_information": [{"code": "70390", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 115.45, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY EXAM OF TEAR DUCT", "code_information": [{"code": "70170", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY FALLOPIAN TUBE", "code_information": [{"code": "74742", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 50.4, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY FOR PANCREAS ENDOSCOPY", "code_information": [{"code": "74329", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 58.03, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE FOR GI TUBE", "code_information": [{"code": "74340", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 44.71, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE GI DILATION", "code_information": [{"code": "74360", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 46.37, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY GUIDE INTESTINAL TUBE", "code_information": [{"code": "74355", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 63.13, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 1.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY MALE GENITAL TRACT", "code_information": [{"code": "74440", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 95.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY NOSE TO RECTUM", "code_information": [{"code": "76010", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 27.06, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 92.09, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCT", "code_information": [{"code": "77053", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 76.54, "methodology": "fee schedule"}, {"payer_name": "AETNA", "plan_name": "AETNA WHOLE HEALTH", "standard_charge_dollar": 774.0, "methodology": "case rate"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "standard_charge_dollar": 5454.0, "methodology": "fee schedule"}, {"payer_name": "CIGNA", "plan_name": "CIGNA HMO/PPO/POS", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 55.6, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 247.53, "methodology": "fee schedule"}, {"payer_name": "UNITED HEALTHCARE", "plan_name": "UHC HMO/PPO/POS", "standard_charge_dollar": 0.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "X-RAY OF MAMMARY DUCTS", "code_information": [{"code": "77054", "type": "CPT"}], "standard_charges": [{"minimum": 0.5, "maximum": 5454.0, "setting": "outpatient", "payers_information": [{"payer_name": "AETNA", "plan_name": "AETNA HMO/PPO/POS", "standard_charge_dollar": 105.44, "methodology": "fee schedule"}, {"payer_name": "AETNA", 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