{"hospital_name": "Texas Spine and Joint Hospital, LLC", "last_updated_on": "2026-04-01", "version": "3.0.0", "pid": "1549956785", "rid": "9283", "location_name": ["Texas Spine & Joint Hospital"], "hospital_address": ["1814 Roseland Blvd, Tyler, TX 75701"], "type_2_npi": ["1942292255"], "license_information": {"license_number": "007902", "state": "TX"}, "attestation": {"attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Geoffrey Vines"}, "standard_charge_information": [{"description": "0.9% SODIUM CHLORIDE IRRIGATION USP 3000", "code_information": [{"code": "90017802", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 63.0, "discounted_cash": 37.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1 LITER CARTRIDGE", "code_information": [{"code": "90011682", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 222.0, "discounted_cash": 133.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1.5 HD 2-RING BINDER TOP OPENING BLUE", "code_information": [{"code": "90031329", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 40.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1/2 MOON/BUTTON", "code_information": [{"code": "90000604", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5554.0, "discounted_cash": 3332.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1/2 NS + KCL 20MEQ 1000ML", "code_information": [{"code": "3510678", "type": "CDM"}, {"code": "258", "type": "RC"}], "standard_charges": [{"gross_charge": 15.0, "discounted_cash": 9.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1/4 MALE NPT FOR SCHARDER DISCONNECT", "code_information": [{"code": "90015817", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 93.0, "discounted_cash": 55.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "12 BUSHEL BLUE POLY TUB", "code_information": [{"code": "90011730", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 804.0, "discounted_cash": 482.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "14 CFFR VACUUM UPRIGHT 2M", "code_information": [{"code": "90005990", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1082.0, "discounted_cash": 649.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "14-3-3 PROTEIN TAU, TOTAL, CSF", "code_information": [{"code": "86317", "type": "CPT"}, {"code": "3001009", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 14.99, "maximum": 77.43, "gross_charge": 166.0, "discounted_cash": 99.6, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 36.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 36.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 77.43, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 51.87, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 69.69, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 51.87, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 51.87, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 77.43, "methodology": "fee 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27.17, "gross_charge": 252.0, "discounted_cash": 151.2, "setting": "both", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 27.17, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 27.17, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 27.17, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "19 ROT YARN BON W/SS", "code_information": [{"code": "90007921", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 121.0, "discounted_cash": 72.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "19.19DRP PACK ENT I FOR EYES", "code_information": [{"code": "90015423", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 317.0, "discounted_cash": 190.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1L GLASS CLEANER", "code_information": [{"code": "90007844", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 230.0, "discounted_cash": 138.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 370.0, "maximum": 7101.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, 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"code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 722.52, "maximum": 729.47, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 729.47, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 722.52, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 722.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [{"code": "C8923", "type": "HCPCS"}], "standard_charges": [{"minimum": 722.52, "maximum": 729.47, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 729.47, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 722.52, "methodology": "case 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{"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 225.17, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 223.02, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1566.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1566.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 223.02, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1566.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DYNAMIC FINE WIRE EMG", "code_information": [{"code": "96003", "type": "CPT"}], "standard_charges": [{"minimum": 283.24, "maximum": 7101.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 285.96, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 283.24, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 283.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DYNAMIC SURFACE EMG", "code_information": [{"code": "96002", "type": "CPT"}], "standard_charges": [{"minimum": 283.24, "maximum": 285.96, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 285.96, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 283.24, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 283.24, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DYSEQUILIBRIUM", "code_information": [{"code": "149", "type": "MS-DRG"}], "standard_charges": [{"minimum": 4448.46, "maximum": 7210.25, "estimated_discounted_cash": 11399.88, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 4448.46, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 4448.46, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7210.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6850.12, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4831.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6489.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4831.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4831.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5049.36, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7210.25, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4831.25, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 5001.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 6403.68, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 6403.68, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 5001.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 6403.68, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Destruction Of Growths In Uterus With Ultrasound Guidance Using An Endoscope", "code_information": [{"code": "404T", "type": "CPT"}], "standard_charges": [{"minimum": 3359.0, "maximum": 7101.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 4242.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 4242.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 4242.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DexmedeTOMIDine(PRECEDEX) 200 MCG/50 mL", "code_information": [{"code": "3512046", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 34.35, "discounted_cash": 20.61, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "DexmedeTOMIDine(PRECEDEX) 200MCG/2ML INJ", "code_information": [{"code": "3510626", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 9.65, "discounted_cash": 5.79, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "Durable Medical Equipment (Other Than Renal) Other", "code_information": [{"code": "299", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "E COLI 0157 AG IA", "code_information": [{"code": "87335", "type": "CPT"}], "standard_charges": [{"minimum": 11.99, "maximum": 169.07, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 169.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 152.16, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 169.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 11.99, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 11.99, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 11.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "E TEST GRADIENT STRIP SUSCEPTIBILITY", "code_information": [{"code": "3000719", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 166.0, "discounted_cash": 99.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "E-Z EM 900ML BOTTLE READI-CAT BARIUM", "code_information": [{"code": "90000947", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 68.0, "discounted_cash": 40.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "EACH ADD CERV OR LUMB VERT BODY 22512", "code_information": [{"code": "22512", "type": "CPT"}, {"code": "1002166", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 370.0, "maximum": 15999.0, "gross_charge": 5999.0, "discounted_cash": 3599.4, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EACH ADDITIONAL 15 MINUTES INTRA-SERVICE", "code_information": [{"code": "24675", "type": "CPT"}, {"code": "1001664", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 370.0, "maximum": 3361.0, "gross_charge": 1078.0, "discounted_cash": 646.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1464.27, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1450.32, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1450.32, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EACH ADDITIONAL LEVEL", "code_information": [{"code": "22522", "type": "CPT"}, {"code": "1000465", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 5999.0, "discounted_cash": 3599.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "EACH ADDITIONAL NAIL PLATE", "code_information": [{"code": "11732", "type": "CPT"}, {"code": "1000269", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 370.0, "maximum": 3361.0, "gross_charge": 1078.0, "discounted_cash": 646.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "EACH ADDITIONAL SEGMENT THORACIC OR LUMB", "code_information": [{"code": "63057", "type": "CPT"}, {"code": "1001998", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 370.0, "maximum": 15999.0, "gross_charge": 4422.0, "discounted_cash": 2653.2, "setting": "outpatient", 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HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 6.9, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CLADRIBINE PER 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9065", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.72, "maximum": 15.87, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15.87, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 15.72, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 15.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CRIZANLIZUMAB-TMCA 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0791", "type": "HCPCS"}], "standard_charges": [{"minimum": 120.61, "maximum": 121.77, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 121.77, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 120.61, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 120.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CROTALIDAE IM F(AB')2 EQ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0841", "type": "HCPCS"}], "standard_charges": [{"minimum": 991.89, "maximum": 1001.43, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1001.43, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 991.89, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 991.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CUTAQUIG 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1551", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.07, "maximum": 13.2, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 13.2, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 13.07, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 13.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CUVITRU, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1555", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.99, "maximum": 15.13, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 15.13, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 14.99, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 14.99, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOS DR.REDDY'S 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9072", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.66, "maximum": 3.7, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.7, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3.66, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOSPHAMD AUROMEDIC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.66, "maximum": 1.68, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.68, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.66, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DAUNORUBICIN, CYTARABINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9153", "type": "HCPCS"}], "standard_charges": [{"minimum": 220.49, "maximum": 222.61, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 222.61, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 220.49, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 220.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DELANDISTROGENE MOX ROKL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1413", "type": "HCPCS"}], "standard_charges": [{"minimum": 3162911.87, "maximum": 3193324.48, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3193324.48, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3162911.87, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3162911.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DIAG/THERAPEUTIC AGENT PARAVERTEBRAL", "code_information": [{"code": "64494", "type": "CPT"}, {"code": "1300154", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 370.0, "maximum": 3361.0, "gross_charge": 1078.0, "discounted_cash": 646.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DIAGNOSTIC/THERAPEUTIC AGENT PARAVER", "code_information": [{"code": "64493", "type": "CPT"}, {"code": "1300153", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 822.51, "maximum": 3361.0, "gross_charge": 4422.0, "discounted_cash": 2653.2, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 830.42, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 822.51, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1186.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1186.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 822.51, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1186.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ DUPUYTREN CORD W/ENZYME", "code_information": [{"code": "20527", "type": "CPT"}], "standard_charges": [{"minimum": 267.27, "maximum": 3361.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 269.84, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 267.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 267.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EFGART-ALFA 2MG HYA-QVFC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9334", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.41, "maximum": 31.71, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 31.71, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 31.41, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 31.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EFGARTIGIMOD 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9332", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.37, "maximum": 30.66, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 30.66, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 30.37, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 30.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EFLAPEGRASTIM-XNST 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1449", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.27, "maximum": 26.52, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 26.52, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 26.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 26.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ENFORT VEDO-EJFV 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9177", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.29, "maximum": 34.62, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 34.62, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 34.29, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 34.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ EPCORITAMAB-BYSP 0.16 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9321", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.93, "maximum": 51.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 51.42, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 50.93, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 50.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ESMOLOL HCL WG CRIT CARE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1806", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.4, "maximum": 0.41, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.41, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.4, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ESTROGEN CONJUGATE 25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1410", "type": "HCPCS"}], "standard_charges": [{"minimum": 352.67, "maximum": 356.06, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 356.06, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 352.67, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 352.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FENSOLVI 0.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1951", "type": "HCPCS"}], "standard_charges": [{"minimum": 124.74, "maximum": 125.94, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 125.94, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 124.74, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 124.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC CARBOXYMALTOS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1439", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.04, "maximum": 1.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.05, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.04, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ FOSNETUPITANT, PALONOSET", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1454", "type": "HCPCS"}], "standard_charges": [{"minimum": 670.87, "maximum": 677.32, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 677.32, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 670.87, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 670.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GEMCITABINE HCL (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9196", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.01, "maximum": 4.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 4.05, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 4.01, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 4.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GIVOSIRAN 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0223", "type": "HCPCS"}], "standard_charges": [{"minimum": 106.09, "maximum": 107.11, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 107.11, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 106.09, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 106.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GLOFITAMAB GXBM, 2.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9286", "type": "HCPCS"}], "standard_charges": [{"minimum": 2564.04, "maximum": 2588.69, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2588.69, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2564.04, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2564.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ GLUCAGON HCL, FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1611", "type": "HCPCS"}], "standard_charges": [{"minimum": 122.07, "maximum": 123.24, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 123.24, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 122.07, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 122.07, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN, PFIZER, 1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1643", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.11, "maximum": 4.15, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 4.15, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 4.11, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 4.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HERZUMA 10 MG", "code_information": [{"code": "Q5113", "type": "HCPCS"}], "standard_charges": [{"minimum": 52.85, "maximum": 53.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 53.35, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 52.85, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 52.85, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HUMAN FIBRINOGEN CON NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7178", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.37, "maximum": 1.38, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.38, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.37, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ HYDROXYPROGST CAPOAT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1729", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.22, "maximum": 17.38, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 17.38, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 17.22, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 17.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IMIP 4 CILAS 4 RELEB 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0742", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.32, "maximum": 2.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.34, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2.32, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ INOTUZUMAB OZOGAM 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9229", "type": "HCPCS"}], "standard_charges": [{"minimum": 2443.65, "maximum": 2467.15, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2467.15, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2443.65, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2443.65, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ INTRALESIONAL UP TO 7 LESIONS", "code_information": [{"code": "11900", "type": "CPT"}, {"code": "1002081", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 180.66, "maximum": 3361.0, "gross_charge": 1455.0, "discounted_cash": 873.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 182.4, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 180.66, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 180.66, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IRINOTECAN LIPOSOME 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9205", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.09, "maximum": 60.66, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 60.66, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 60.09, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 60.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IRON DEXTRAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1750", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.4, "maximum": 16.56, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.56, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 16.4, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 16.4, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ IVIG PRIVIGEN 500 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1459", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.33, "maximum": 45.76, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 45.76, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 45.33, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 45.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LABETALOL HCL HIKMA, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1921", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.25, "maximum": 2.27, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.27, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2.25, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LEFAMULIN 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0691", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.69, "maximum": 0.69, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.69, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.69, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LEVOLEUCOVORIN NOS 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0641", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.05, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.05, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LON TESIRIN-LPYL 0.075MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9359", "type": "HCPCS"}], "standard_charges": [{"minimum": 189.89, "maximum": 191.71, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 191.71, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 189.89, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 189.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LUSPATERCEPT-AAMT 0.25MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0896", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.87, "maximum": 38.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 38.23, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 37.87, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 37.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ LUXTURNA 1 BILLION VEC G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3398", "type": "HCPCS"}], "standard_charges": [{"minimum": 2770.06, "maximum": 2796.7, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2796.7, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2770.06, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2770.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MELPHA HYDROCH NOS 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9245", "type": "HCPCS"}], "standard_charges": [{"minimum": 158.89, "maximum": 160.41, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 160.41, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 158.89, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 158.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MIDAZOLAM (WG CRIT CARE)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2251", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.25, "maximum": 0.25, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.25, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.25, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.25, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MOGAMULIZUMAB-KPKC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9204", "type": "HCPCS"}], "standard_charges": [{"minimum": 221.78, "maximum": 223.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 223.91, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 221.78, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 221.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MOSUNETUZUMAB-AXGB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9350", "type": "HCPCS"}], "standard_charges": [{"minimum": 595.86, "maximum": 601.59, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 601.59, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 595.86, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 595.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MOXIFLOXACIN (FRES KABI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2281", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.09, "maximum": 7.16, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 7.16, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 7.09, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 7.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ MVASI 10 MG", "code_information": [{"code": "Q5107", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.33, "maximum": 25.58, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 25.58, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 25.33, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 25.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ NIVOL RELATLIMAB 3MG/1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9298", "type": "HCPCS"}], "standard_charges": [{"minimum": 177.11, "maximum": 178.81, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 178.81, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 177.11, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 177.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ OGIVRI 10 MG", "code_information": [{"code": "Q5114", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.31, "maximum": 59.88, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 59.88, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 59.31, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 59.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ OLIPUDASE ALFA-RPCP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0218", "type": "HCPCS"}], "standard_charges": [{"minimum": 356.66, "maximum": 360.09, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 360.09, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 356.66, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 356.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ONASE ABEPAR-XIOI TREAT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3399", "type": "HCPCS"}], "standard_charges": [{"minimum": 2152379.95, "maximum": 2173075.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2173075.91, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2152379.95, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2152379.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ONTRUZANT 10 MG", "code_information": [{"code": "Q5112", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.26, "maximum": 32.57, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 32.57, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 32.26, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 32.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRAST EX BIO 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2506", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.95, "maximum": 104.95, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 104.95, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 103.95, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 103.95, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRASTIM-BMEZ 0.5MG", "code_information": [{"code": "Q5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 328.41, "maximum": 331.57, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 331.57, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 328.41, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 328.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMBROLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}], "standard_charges": [{"minimum": 54.28, "maximum": 54.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 54.8, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 54.28, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 54.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (ACCORD) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9296", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.15, "maximum": 9.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9.23, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 9.15, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 9.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (SANDOZ) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9297", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.34, "maximum": 1.36, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.36, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.34, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (TEVA) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9314", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.43, "maximum": 9.52, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9.52, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 9.43, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 9.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED DITROMETHAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9323", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.8, "maximum": 9.89, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9.89, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 9.8, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 9.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED, HOSPIRA 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.43, "maximum": 3.46, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.46, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3.43, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PLASMINOGEN TVMH 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2998", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.12, "maximum": 30.41, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 30.41, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 30.12, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 30.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ PROCEDURE FOR HIP ARTHROGRAPHY; WITH", "code_information": [{"code": "27095", "type": "CPT"}, {"code": "1300051", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 370.0, "maximum": 3361.0, "gross_charge": 1455.0, "discounted_cash": 873.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RECOMBIN ESPEROCT PER IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7204", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.0, "maximum": 2.02, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.02, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT ESRD ON DIALYSI", "code_information": [{"code": "Q5105", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.71, "maximum": 0.72, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.72, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.71, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.71, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT NON-ESRD USE", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.11, "maximum": 7.18, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 7.18, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 7.11, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 7.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RISANKIZUMAB-RZAA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2327", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.21, "maximum": 14.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 14.35, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 14.21, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 14.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RISPERDAL CONSTA, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2794", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.54, "maximum": 11.65, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11.65, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 11.54, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 11.54, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RITUXIMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9311", "type": "HCPCS"}], "standard_charges": [{"minimum": 35.27, "maximum": 35.61, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 35.61, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 35.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 35.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ROCTAVIAN ML 2X10^13VC G", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1412", "type": "HCPCS"}], "standard_charges": [{"minimum": 11050.72, "maximum": 11156.98, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11156.98, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 11050.72, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 11050.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN LYOPHIL 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9319", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.93, "maximum": 29.21, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 29.21, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 28.93, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 28.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ ROMIDEPSIN NON-LYO 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9318", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.11, "maximum": 32.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 32.42, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 32.11, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 32.11, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RONZANOLIXIZUM-NOLI 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9333", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.64, "maximum": 21.85, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 21.85, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 21.64, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 21.64, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ RUXIENCE, 10 MG", "code_information": [{"code": "Q5119", "type": "HCPCS"}], "standard_charges": [{"minimum": 19.2, "maximum": 19.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 19.39, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 19.2, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 19.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SACROILIAC JOINT; PROVISION OF ANEST", "code_information": [{"code": "G0260", "type": "HCPCS"}, {"code": "1300088", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 624.04, "maximum": 3361.0, "gross_charge": 2845.0, "discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 630.04, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 624.04, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1186.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1186.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 624.04, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1186.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SEBELIPASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2840", "type": "HCPCS"}], "standard_charges": [{"minimum": 509.96, "maximum": 514.87, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 514.87, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 509.96, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 509.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SECRETIN SYNTHETIC HUMAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2850", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.53, "maximum": 39.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 39.91, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 39.53, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 39.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SIROLIMUS PROT PART 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9331", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.51, "maximum": 104.5, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 104.5, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 103.51, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 103.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ SODIUM THIOSULFATE 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0208", "type": "HCPCS"}], "standard_charges": [{"minimum": 90.78, "maximum": 91.65, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 91.65, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 90.78, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 90.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TALIMOGENE LAHERPAREPVEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 63.27, "maximum": 63.88, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 63.88, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 63.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 63.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TBO FILGRASTIM 1 MICROG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1447", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.39, "maximum": 0.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.39, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.39, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TECLISTAMAB CQYV 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9380", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.13, "maximum": 29.41, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 29.41, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 29.13, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 29.13, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEDIZOLID PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3090", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.72, "maximum": 1.74, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.74, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.72, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEPLIZUMAB MZWV 5 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9381", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.46, "maximum": 34.79, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 34.79, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 34.46, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 34.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TEZEPELUMAB-EKKO, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2356", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.86, "maximum": 17.02, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 17.02, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 16.86, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 16.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TISOTU VEDOTIN-TFTV, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9273", "type": "HCPCS"}], "standard_charges": [{"minimum": 165.55, "maximum": 167.14, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 167.14, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 165.55, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 165.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TOFERSEN INTRATHEC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1304", "type": "HCPCS"}], "standard_charges": [{"minimum": 142.86, "maximum": 144.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 144.23, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 142.86, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 142.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRASTUZUMAB EXCL BIOSIMI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 75.81, "maximum": 76.54, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 76.54, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 75.81, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 75.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRIAMCINOLONE ACE XR 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3304", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.57, "maximum": 16.72, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.72, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 16.57, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 16.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ TRUXIMA 10 MG", 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"J0217", "type": "HCPCS"}], "standard_charges": [{"minimum": 401.57, "maximum": 405.43, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 405.43, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 401.57, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 401.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 193.42, "maximum": 3361.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 195.28, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 193.42, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 193.42, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ XIPERE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3299", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.01, "maximum": 46.46, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 46.46, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 46.01, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 46.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ABILIFY ASIMTUFII, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0402", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.5, "maximum": 5.55, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.55, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 5.5, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 5.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (B BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.05, "maximum": 0.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.05, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.05, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (HIKMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0137", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.06, "maximum": 0.06, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.06, "methodology": "case 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{"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0172", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.66, "maximum": 5.72, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.72, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 5.66, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 5.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, AFSTYLA, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7210", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.38, "maximum": 1.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.39, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.38, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, AMISULPRIDE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0184", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.6, "maximum": 8.68, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 8.68, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 8.6, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 8.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, AMIVANTAMAB-VMJW", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9061", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.93, "maximum": 19.11, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 19.11, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 18.93, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 18.93, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, APONVIE, 1 MG", "code_information": [{"code": "C9145", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.78, "maximum": 1.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.8, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.78, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ARTESUNATE, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0391", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.31, "maximum": 45.75, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 45.75, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 45.31, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 45.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ASPARA, RYLAZE, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9021", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.49, "maximum": 48.96, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 48.96, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 48.49, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 48.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ATEZOLIZUMAB,10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9022", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.49, "maximum": 80.26, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 80.26, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 79.49, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 79.49, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BENDAMUSTINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9056", "type": "HCPCS"}], "standard_charges": [{"minimum": 32.22, "maximum": 32.53, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 32.53, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 32.22, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 32.22, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BEZLOTOXUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0565", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.76, "maximum": 38.13, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 38.13, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 37.76, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 37.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BIORPHEN, 20 MICROGRAMS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2372", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.16, "maximum": 0.17, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.17, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.16, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB FRESENIUSKAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9048", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.98, "maximum": 46.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 46.42, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 45.98, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 45.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, DR. REDDY'S", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9046", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.98, "maximum": 46.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 46.42, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 45.98, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 45.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, BORTEZOMIB, HOSPIRA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9049", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.63, "maximum": 1.64, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.64, "methodology": "case rate"}, 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{"description": "INJ, ELAHERE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9063", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.21, "maximum": 62.81, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 62.81, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 62.21, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 62.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, EPINEPHRINE (BELCHER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0173", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.79, "maximum": 1.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.8, "methodology": 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{"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0606", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.32, "maximum": 2.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.34, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2.32, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, EVINACUMAB-DGNB, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1305", "type": "HCPCS"}], "standard_charges": [{"minimum": 169.66, "maximum": 171.29, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 171.29, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 169.66, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 169.66, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, FACTOR X, (HUMAN), 1IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7175", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.63, "maximum": 8.71, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 8.71, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 8.63, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 8.63, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, FARICIMAB-SVOA, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, 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"payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 13.65, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 13.52, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 13.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, IXINITY, 1 I.U.", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7213", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.74, "maximum": 1.76, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.76, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.74, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.74, 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{"description": "INJ, LECANEMAB-IRMB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0174", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.27, "maximum": 1.28, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.28, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, LENACAPAVIR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1961", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.85, "maximum": 21.05, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 21.05, 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"drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9247", "type": "HCPCS"}], "standard_charges": [{"minimum": 404.32, "maximum": 408.2, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 408.2, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 404.32, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 404.32, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, MEROPENEM (B. 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"Health First", "plan_name": "TPA", "standard_charge_dollar": 0.02, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, MICAFUNGIN (PAR PHARM)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2247", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.26, "maximum": 0.26, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.26, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.26, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, MORPHINE (FRESENIUS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2272", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.89, "maximum": 6.96, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.96, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 6.89, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 6.89, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, NALOXONE HCL (ZIMHI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2311", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.96, "maximum": 6.02, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.02, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 5.96, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 5.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, NITROGLYCERIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2305", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.36, "maximum": 1.38, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.38, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.36, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.36, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, NUSINERSEN, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2326", "type": "HCPCS"}], 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"standard_charge_dollar": 62.04, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, OLICERIDINE 0.1 MG", "code_information": [{"code": "C9101", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.23, "maximum": 1.25, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.25, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.23, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, OMACETAXINE MEP, 0.01MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9262", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.74, "maximum": 3.78, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv 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"INJ, PASIREOTIDE LONG ACTING", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2502", "type": "HCPCS"}], "standard_charges": [{"minimum": 438.7, "maximum": 442.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 442.91, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 438.7, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 438.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, PEGCETACOPLAN, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2781", "type": "HCPCS"}], "standard_charges": [{"minimum": 141.97, "maximum": 143.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 143.34, 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"code_information": [{"code": "Q5125", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.5, "maximum": 0.5, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.5, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.5, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.5, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, REMDESIVIR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0248", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.74, "maximum": 5.79, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.79, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 5.74, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 5.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, RETIFANLIMAB-DLWR, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9345", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.94, "maximum": 28.21, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 28.21, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 27.94, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 27.94, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, REZAFUNGIN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0349", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.59, "maximum": 9.68, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 9.68, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 9.59, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 9.59, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, RIMABOTULINUMTOXINB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0587", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.35, "maximum": 12.46, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 12.46, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 12.35, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 12.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, SCULPTRA, 0.5MG", "code_information": [{"code": "Q2028", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.33, "maximum": 1.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.34, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.33, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, SPESOLIMAB-SBZO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1747", "type": "HCPCS"}], "standard_charges": [{"minimum": 56.97, "maximum": 57.51, "setting": "outpatient", "payers_information": 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{"description": "INJ, SUSVIMO 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2779", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.12, "maximum": 76.85, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 76.85, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 76.12, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 76.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, SUTIMLIMAB-JOME, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1302", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.83, "maximum": 16.99, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.99, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 16.83, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 16.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, TALIGLUCERASE ALFA 10 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3060", "type": "HCPCS"}], "standard_charges": [{"minimum": 42.62, "maximum": 43.03, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 43.03, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 42.62, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 42.62, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, TEBENTAFUSP-TEBN, 1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9274", "type": "HCPCS"}], "standard_charges": [{"minimum": 197.87, "maximum": 199.78, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 199.78, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 197.87, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 197.87, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, TREMELIMUMAB-ACTL, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9347", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.56, "maximum": 129.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 129.8, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 128.56, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 128.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, TRIVISC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7329", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.03, "maximum": 7.1, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 7.1, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 7.03, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 7.03, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, UZEDY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.12, "maximum": 23.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 23.34, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 23.12, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 23.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (MYLAN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3371", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.55, "maximum": 5.61, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.61, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 5.55, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 5.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (XELLIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3372", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.06, "maximum": 6.12, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.12, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 6.06, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 6.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VASOPRESSIN, 1 UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2598", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.78, "maximum": 1.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.8, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.78, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VEGZELMA, 10 MG", "code_information": [{"code": "Q5129", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.6, "maximum": 66.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 66.23, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 65.6, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 65.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VINCRISTINE SUL LIP 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9371", "type": "HCPCS"}], "standard_charges": [{"minimum": 3239.82, "maximum": 3270.97, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3270.97, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3239.82, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3239.82, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, VUTRISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0225", "type": "HCPCS"}], "standard_charges": [{"minimum": 4674.14, "maximum": 4719.08, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 4719.08, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 4674.14, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 4674.14, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ, ZIV-AFLIBERCEPT, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9400", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.33, "maximum": 6.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 6.39, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 6.33, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 6.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. (ANI), UP TO 40 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0802", "type": "HCPCS"}], "standard_charges": [{"minimum": 3187.28, "maximum": 3217.92, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3217.92, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3187.28, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3187.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. ACTHAR GEL TO 40 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0801", "type": "HCPCS"}], "standard_charges": [{"minimum": 3192.09, "maximum": 3222.78, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3222.78, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3192.09, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3192.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. ANESTHETIC AGENT; FEMORAL NERVE; SI", "code_information": [{"code": "64447", "type": "CPT"}, {"code": "1300023", "type": "CDM"}, {"code": "361", "type": "RC"}], "standard_charges": [{"minimum": 624.04, "maximum": 15999.0, "gross_charge": 2087.0, "discounted_cash": 1252.2, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 7568.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 15199.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 14399.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 630.04, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 15999.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 10719.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 624.04, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1186.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1186.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 624.04, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1186.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. ASCENIV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1554", "type": "HCPCS"}], "standard_charges": [{"minimum": 465.41, "maximum": 469.88, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 469.88, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 465.41, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 465.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. AVSOLA, 10 MG", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.08, "maximum": 23.31, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 23.31, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 23.08, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 23.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. BELRAPZO/BENDAMUSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.41, "maximum": 8.49, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 8.49, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 8.41, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 8.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. BYOOVIZ, 0.1 MG", "code_information": [{"code": "Q5124", "type": "HCPCS"}], "standard_charges": [{"minimum": 165.8, "maximum": 167.39, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 167.39, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 165.8, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 165.8, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. CEFEPIME HCL (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0701", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.46, "maximum": 5.51, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 5.51, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 5.46, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 5.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. CETIRIZINE HCL 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1201", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.18, "maximum": 14.32, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 14.32, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 14.18, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 14.18, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. EPTINEZUMAB-JJMR 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3032", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.09, "maximum": 17.26, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 17.26, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 17.09, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 17.09, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. FE DERISOMALTOSE 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1437", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.88, "maximum": 19.06, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 19.06, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 18.88, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 18.88, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. HERCEPTIN HYLECTA, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9356", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.44, "maximum": 63.04, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 63.04, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 62.44, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 62.44, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. INEBILIZUMAB-CDON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1823", "type": "HCPCS"}], "standard_charges": [{"minimum": 448.46, "maximum": 452.78, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 452.78, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 448.46, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 448.46, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. INFUGEM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9198", "type": "HCPCS"}], "standard_charges": [{"minimum": 38.15, "maximum": 38.52, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 38.52, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 38.15, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 38.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. ISATUXIMAB-IRFC 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9227", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.38, "maximum": 73.07, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 73.07, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 72.38, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 72.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. JIVI 1 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7208", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.21, "maximum": 2.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.23, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2.21, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2.21, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. LUMASIRAN, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0224", "type": "HCPCS"}], "standard_charges": [{"minimum": 301.27, "maximum": 304.17, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 304.17, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 301.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 301.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. LURBINECTEDIN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9223", "type": "HCPCS"}], "standard_charges": [{"minimum": 188.97, "maximum": 190.79, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 190.79, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 188.97, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 188.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. MARGETUXIMAB-CMKB, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 44.55, "maximum": 44.98, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 44.98, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 44.55, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 44.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. MYCOPHENOLATE MOFETIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.67, "maximum": 0.68, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.68, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.67, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. NAXITAMAB-GQGK, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9348", "type": "HCPCS"}], "standard_charges": [{"minimum": 577.76, "maximum": 583.31, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 583.31, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 577.76, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 577.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. OLANZAPINE, 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2359", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.91, "maximum": 0.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 0.91, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 0.91, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 0.91, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED NOS 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.76, "maximum": 3.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.8, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3.76, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9304", "type": "HCPCS"}], "standard_charges": [{"minimum": 59.74, "maximum": 60.32, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 60.32, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 59.74, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 59.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. RIABNI, 10 MG", "code_information": [{"code": "Q5123", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.23, "maximum": 39.6, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 39.6, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 39.23, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 39.23, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. TAGRAXOFUSP-ERZS 10 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9269", "type": "HCPCS"}], "standard_charges": [{"minimum": 309.37, "maximum": 312.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 312.35, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 309.37, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 309.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. TEPROTUMUMAB-TRBW 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3241", "type": "HCPCS"}], "standard_charges": [{"minimum": 315.76, "maximum": 318.8, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 318.8, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 315.76, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 315.76, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. TIGECYCLINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3244", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.51, "maximum": 2.54, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.54, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2.51, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. VILTOLARSEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1427", "type": "HCPCS"}], "standard_charges": [{"minimum": 55.67, "maximum": 56.2, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 56.2, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 55.67, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 55.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ. XEMBIFY, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1558", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.38, "maximum": 13.51, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 13.51, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 13.38, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 13.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., APREPITANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0185", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.58, "maximum": 1.59, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.59, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.58, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.58, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., ARISTADA INITIO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1943", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.92, "maximum": 2.95, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2.95, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2.92, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BENDEKA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.1, "maximum": 13.23, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 13.23, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 13.1, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 13.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BENRALIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 156.51, "maximum": 158.01, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 158.01, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 156.51, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 156.51, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., BREXANOLONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1632", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.81, "maximum": 68.46, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 68.46, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 67.81, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 67.81, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., CEMIPLIMAB-RWLC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9119", "type": "HCPCS"}], "standard_charges": [{"minimum": 26.12, "maximum": 26.37, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 26.37, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 26.12, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 26.12, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., COPANLISIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 83.02, "maximum": 83.82, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 83.82, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 83.02, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 83.02, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., DURVALUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9173", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.26, "maximum": 76.99, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 76.99, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 76.26, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 76.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., EMAPALUMAB-LZSG, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9210", "type": "HCPCS"}], "standard_charges": [{"minimum": 345.57, "maximum": 348.89, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 348.89, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 345.57, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 345.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., EMICIZUMAB-KXWH 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7170", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.15, "maximum": 48.62, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 48.62, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 48.15, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 48.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., ERAVACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.05, "maximum": 1.06, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.06, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.05, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., EVOMELA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9246", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.0, "maximum": 16.15, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.15, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 16.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 16.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., FIBRYGA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7177", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.34, "maximum": 1.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.35, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.34, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., FREMANEZUMAB-VFRM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3031", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.72, "maximum": 1.74, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.74, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.72, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.72, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., GUSELKUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1628", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.05, "maximum": 67.7, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 67.7, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 67.05, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 67.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., IBALIZUMAB-UIYK, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1746", "type": "HCPCS"}], "standard_charges": [{"minimum": 70.7, "maximum": 71.38, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 71.38, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 70.7, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 70.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., ILUVIEN, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7313", "type": "HCPCS"}], "standard_charges": [{"minimum": 461.75, "maximum": 466.19, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 466.19, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 461.75, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 461.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., KANJINTI, 10 MG", "code_information": [{"code": "Q5117", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.75, "maximum": 16.91, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 16.91, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 16.75, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 16.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., LUMOXITI, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9313", "type": "HCPCS"}], "standard_charges": [{"minimum": 22.16, "maximum": 22.37, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 22.37, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 22.16, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 22.16, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., MEROPENEM, VABORBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2186", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.97, "maximum": 1.99, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1.99, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1.97, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1.97, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., OMADACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.55, "maximum": 3.59, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.59, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3.55, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3.55, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., PATISIRAN, 0.1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0222", "type": "HCPCS"}], "standard_charges": [{"minimum": 93.96, "maximum": 94.86, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 94.86, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 93.96, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 93.96, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., PERSERIS, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2798", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.01, "maximum": 11.12, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 11.12, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 11.01, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 11.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., PLAZOMICIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0291", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.41, "maximum": 3.44, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 3.44, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 3.41, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 3.41, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., RAVULIZUMAB-CWVZ 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1303", "type": "HCPCS"}], "standard_charges": [{"minimum": 210.01, "maximum": 212.03, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 212.03, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 210.01, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 210.01, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., RETISERT, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7311", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.08, "maximum": 28.35, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 28.35, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 28.08, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 28.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., RITUXIMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9312", "type": "HCPCS"}], "standard_charges": [{"minimum": 74.7, "maximum": 75.42, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 75.42, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 74.7, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 74.7, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., TAFASITAMAB-CXIX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.86, "maximum": 12.98, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 12.98, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 12.86, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 12.86, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJ., TILDRAKIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3245", "type": "HCPCS"}], "standard_charges": [{"minimum": 132.81, "maximum": 134.09, "setting": 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schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 35.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 35.14, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 52.45, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 35.14, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 4.56, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 4.56, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 4.56, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MANUAL RETICULOCYTE COUNT", "code_information": [{"code": "85044", "type": "CPT"}], "standard_charges": [{"minimum": 4.31, "maximum": 4.31, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 4.31, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 4.31, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 4.31, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MAP PADS", "code_information": [{"code": "90005131", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 8.0, "discounted_cash": 4.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MAP TACHYCARDIA ADD-ON", "code_information": [{"code": "93609", "type": "CPT"}], "standard_charges": [{"minimum": 370.0, "maximum": 6891.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3259.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3259.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 6891.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6546.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6201.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 6891.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4617.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MARCAINE W EPI 10ML VIAL", "code_information": [{"code": "90010413", "type": "CDM"}, {"code": "259", "type": "RC"}], "standard_charges": [{"gross_charge": 16.94, "discounted_cash": 10.16, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARCAINE W EPI 30ML VIAL", "code_information": [{"code": "90010414", "type": "CDM"}, {"code": "259", "type": "RC"}], "standard_charges": [{"gross_charge": 39.62, "discounted_cash": 23.77, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARCAINE W EPI 50ML", "code_information": [{"code": "90010416", "type": "CDM"}, {"code": "259", "type": "RC"}], "standard_charges": [{"gross_charge": 33.81, "discounted_cash": 20.29, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARGARINE CUP", "code_information": [{"code": "90010186", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 151.0, "discounted_cash": 90.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARK A MATIC II INKING SYSTEM", "code_information": [{"code": "90008829", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 536.0, "discounted_cash": 321.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARKER BIG GRIP BLACK", "code_information": [{"code": "90004445", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 78.0, "discounted_cash": 46.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARKER SKIN FINE TIP", "code_information": [{"code": "90011202", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 246.0, "discounted_cash": 147.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARKER SKIN MARKER MINI NON-STERILE", "code_information": [{"code": "90030489", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARKER VISCOT MINI SKIN MARKER", "code_information": [{"code": "90010682", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 2.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARKERS DRY ERASE ASSORTED", "code_information": [{"code": "90004281", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 57.05, "discounted_cash": 34.23, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARKERS DRY ERASE ASSORTED", "code_information": [{"code": "90006266", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 20.79, "discounted_cash": 12.47, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARSCHMALLOW JET PUFFED MINI", "code_information": [{"code": "90010872", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 103.0, "discounted_cash": 61.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MARSUPIALIZATION ODON CYST", "code_information": [{"code": "D7509", "type": "HCPCS"}], "standard_charges": [{"minimum": 1792.0, "maximum": 1792.0, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1792.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1792.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MASIMO ADULT FINGER SENSOR DIRECT CONNEC", "code_information": [{"code": "90015121", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 594.0, "discounted_cash": 356.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASIMO FINGERTIP SENSOR 18 ADLT MAS1859", "code_information": [{"code": "90099222", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 31.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO FINGERTIP SENSOR 18 PEDI MAS1860", "code_information": [{"code": "90021160", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 31.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO FINGERTIP SENSOR 18IN INFAMAS1859", "code_information": [{"code": "90021161", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 69.0, "discounted_cash": 41.4, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO FINGERTIP SENSOR 18IN PEDI", "code_information": [{"code": "80008501", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 31.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASIMO INFANT ADHESIVE SENSOR CABLE 4FT", "code_information": [{"code": "90021404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 43.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASIMO INFANT ADHESIVE SENSOR SpO2 OPSS", "code_information": [{"code": "90030138", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 43.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASIMO PEDI ADHESIVE SENSOR SpO2", "code_information": [{"code": "90012882", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 891.0, "discounted_cash": 534.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASIMO RD RAINBOW SET MD20-12", "code_information": [{"code": "90011262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 31.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO RD SET", "code_information": [{"code": "90021162", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 31.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO RD SET EAR ADT SENSOR", "code_information": [{"code": "90047652", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 370.8, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO RD SET INF SENSOR", "code_information": [{"code": "90021164", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 40.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO RD SET INF SENSOR", "code_information": [{"code": "90021165", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 40.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO RD SET MD20-12", "code_information": [{"code": "90021166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 31.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO RD SET PDT SENSOR", "code_information": [{"code": "90021163", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 52.0, "discounted_cash": 31.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASIMO RD SET REUSABLE SENSOR", "code_information": [{"code": "90003916", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 67.0, "discounted_cash": 40.2, "setting": "both", "billing_class": "facility"}]}, {"description": "MASK ADULT 7FT O2 TUBE & MASK O2-LOCK VE", "code_information": [{"code": "90080010", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 4.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK BITRAC FULLFACE ADULT LARGE", "code_information": [{"code": "90016299", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 351.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK BITRAC FULLFACE ADULT MEDIUM", "code_information": [{"code": "90016298", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 351.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK BITRAC FULLFACE ADULT SMALL", "code_information": [{"code": "90016297", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 586.0, "discounted_cash": 351.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK CLASSIC PLEATED FACE", "code_information": [{"code": "90005981", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 35.0, "discounted_cash": 21.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK DISP ELONG AEOR W/O TUBING", "code_information": [{"code": "90008323", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK FACE GREEN SURGICAL 653322", "code_information": [{"code": "80000271", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 2.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK FACE LGE ADULT SZ 6 INFLAT", "code_information": [{"code": "90000552", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 25.0, "discounted_cash": 15.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK FACE TENT ADULT UNDER THE CHIN W/6'", "code_information": [{"code": "90000531", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 13.09, "discounted_cash": 7.85, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK FLUID GUARD LEVEL 3 SENSITIVE SKIN", "code_information": [{"code": "90040486", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK FLUID GUARD LEVEL 3 STAFF", "code_information": [{"code": "90040215", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK FOG FREE LASER SILVER", "code_information": [{"code": "90005289", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 114.0, "discounted_cash": 68.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK HARNESS ADULT BLACK", "code_information": [{"code": "90000955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 83.0, "discounted_cash": 49.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK INFLATABLE KING MEDIUM ADULT", "code_information": [{"code": "90010499", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 509.0, "discounted_cash": 305.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK INFLATABLE KING SZ3 TODDLER", "code_information": [{"code": "90010498", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 24.0, "discounted_cash": 14.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK NASAL C-PAP MED/LG 73-1016691", "code_information": [{"code": "90018859", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 160.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK NASAL C-PAP SM 73-1016693", "code_information": [{"code": "90018858", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 268.0, "discounted_cash": 160.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK NON-REBREATHER HIGH OXYGEN 3-IN-1 W", "code_information": [{"code": "80000514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 3.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK NON-REBREATHER HIGH OXYGEN 3-IN-1 W", "code_information": [{"code": "90013085", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 3.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK OXYGEN DISPOSABLE", "code_information": [{"code": "90003043", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK OXYGEN DISPOSABLE 1041", "code_information": [{"code": "80002019", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 2.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK OXYGEN DISPOSABLE PEDI", "code_information": [{"code": "90040156", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 2.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK PLEAT FLUID RESIST FOG FREE ORANGE", "code_information": [{"code": "90014109", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 61.0, "discounted_cash": 36.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK PROCEDURAL YELLOW/BLUE", "code_information": [{"code": "90040075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK RESPIRATOR N95 HONEYWELL", "code_information": [{"code": "80001500", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 28.0, "discounted_cash": 16.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK RESPIRATOR REGULAR 46767", "code_information": [{"code": "80000809", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 2.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK SMALL PERFORMATRAK", "code_information": [{"code": "90007297", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 316.0, "discounted_cash": 189.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK SURG ANTI-FOG", "code_information": [{"code": "80000810", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 72.0, "discounted_cash": 43.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK SURG ANTI-FOG GREEN", "code_information": [{"code": "90003124", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 2.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK SURGICAL ANTI FOG VISOR W LOOPS", "code_information": [{"code": "90014237", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 122.0, "discounted_cash": 73.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK SURGICAL ANTI FOG W LOOPS", "code_information": [{"code": "90014236", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "MASK SURGICAL DERMA TOUCH", "code_information": [{"code": "90003125", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.2, "setting": "inpatient", "billing_class": 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{"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 3869.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 3869.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", 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"gross_charge": 2766.0, "discounted_cash": 1659.6, "setting": "both", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5196.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4922.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 1389.42, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 1376.18, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 3210.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 3210.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 1376.18, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 3210.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY", "code_information": [{"code": "69420", "type": "CPT"}, {"code": "1001712", "type": "CDM"}, {"code": "490", "type": "RC"}], "standard_charges": [{"minimum": 220.42, "maximum": 5469.0, "gross_charge": 1455.0, "discounted_cash": 873.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5196.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4922.1, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 222.54, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5469.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3664.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 220.42, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 220.42, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY INCLUDING ASPIRATION AND OR", "code_information": [{"code": "69421", "type": "CPT"}, {"code": "1001655", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1566.0, "maximum": 5511.0, "gross_charge": 1455.0, "discounted_cash": 873.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2607.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 5235.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 4959.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 2933.28, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 5511.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 3692.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 2905.34, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1566.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1566.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 2905.34, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1566.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MYRINGOTOMY LASER-ASSIST", "code_information": [{"code": "S2225", "type": "HCPCS"}], "standard_charges": [{"minimum": 2587.0, "maximum": 5469.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 2587.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 2587.0, "methodology": "fee 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Of Diameters Of Pelvis In Female", "code_information": [{"code": "74710", "type": "CPT"}], "standard_charges": [{"minimum": 93.45, "maximum": 237.67, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 112.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 112.42, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 237.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 159.24, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 213.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 159.24, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 159.24, "methodology": "fee 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of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices Other Implants", "code_information": [{"code": "278", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 40.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices Pacemaker", "code_information": [{"code": "275", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Medical/Surgical Supplies And Devices, Prosthetic/Orthotic Devices", "code_information": [{"code": "274", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3300.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Methadone", "code_information": [{"code": "80101", "type": "CPT"}, {"code": "3000342", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 161.0, "discounted_cash": 96.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "Methadone", "code_information": [{"code": "80101", "type": "CPT"}, {"code": "3000351", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 28.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "Methamphetamines", "code_information": [{"code": "80101", "type": "CPT"}, {"code": "3000347", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"gross_charge": 48.0, "discounted_cash": 28.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "Molecular Pathology Test For Risk Of Serious Liver Disease Within 5 Years (Enhanced Liver Fibrosis (Elf) Test)", "code_information": [{"code": "14M", "type": "CPT"}], "standard_charges": [{"minimum": 158.57, "maximum": 158.57, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 158.57, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 158.57, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 158.57, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ COMMON DIGIT", "code_information": [{"code": "64632", "type": "CPT"}], "standard_charges": [{"minimum": 267.27, "maximum": 3361.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 269.84, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 267.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 267.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N BLOCK INJ HYPOGAS PLXS", "code_information": [{"code": "64517", "type": "CPT"}], "standard_charges": [{"minimum": 822.51, "maximum": 3361.0, "estimated_discounted_cash": 2752.5, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 3193.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 3024.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 830.42, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 3361.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 2252.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 822.51, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1186.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1186.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 822.51, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1186.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N-CONNECT OXIMETER CABLE DATEX OHMEDA", "code_information": [{"code": "90006273", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 289.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "N-INVAS EST C FFR SW ALY CTA", "code_information": [{"code": "75580", "type": "CPT"}], "standard_charges": [{"minimum": 943.48, "maximum": 952.55, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 952.55, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 943.48, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 943.48, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N-NVS ARTL PLAQ ALYS QUAN", "code_information": [{"code": "712T", "type": "CPT"}], "standard_charges": [{"minimum": 82.0, "maximum": 82.79, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 82.79, "methodology": "case rate"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 82.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 82.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N. GONORRHOEAE ASSAY W/OPTIC", "code_information": [{"code": "87850", "type": "CPT"}], "standard_charges": [{"minimum": 22.1, "maximum": 169.07, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 79.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 169.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 152.16, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 169.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 113.28, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 22.1, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 22.1, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 22.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA DIR PROB", "code_information": [{"code": "87590", "type": "CPT"}], "standard_charges": [{"minimum": 24.19, "maximum": 99.62, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 47.12, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 47.12, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 99.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 66.75, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 89.66, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 66.75, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 66.75, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 99.62, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 66.75, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 24.19, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 24.19, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 24.19, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "N.GONORRHOEAE DNA QUANT", "code_information": [{"code": "87592", "type": "CPT"}], "standard_charges": [{"minimum": 42.84, "maximum": 399.97, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 189.19, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 189.19, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 399.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 267.98, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 359.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 267.98, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 267.98, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 399.97, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 267.98, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 42.84, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 42.84, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 42.84, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NA DISF BTH CLEANER", "code_information": [{"code": "90007310", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 343.0, "discounted_cash": 205.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NACL 0.9% INHALATION 3ML SOLN", "code_information": [{"code": "3511831", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NAFCILLIN 1 GRAM INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2290", "type": "HCPCS"}, {"code": "3510352", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 38.8, "discounted_cash": 23.28, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NAFCILLIN 2G/100ML IVPB", "code_information": [{"code": "3512023", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "inpatient", 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5.0, "discounted_cash": 3.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NF-CEFUROXIME AXETIL 500MG TAB", "code_information": [{"code": "3530739", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NF-CEFUROXIME SOD VL:1.5GM", "code_information": [{"code": "3510081", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 62.0, "discounted_cash": 37.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NF-CELECOXIB 100MG CAP", "code_information": [{"code": "3531552", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NF-CEPHALEXIN 500MG CAP", "code_information": [{"code": "3535268", "type": "CDM"}, {"code": "259", "type": "RC"}], 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{"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 142.31, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 140.96, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 370.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 140.96, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 370.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "202U", "type": "CPT"}], "standard_charges": [{"minimum": 375.1, "maximum": 375.1, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 375.1, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 375.1, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 375.1, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", 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"methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 141.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM POS", "code_information": [{"code": "141U", "type": "CPT"}], "standard_charges": [{"minimum": 141.08, "maximum": 141.08, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 141.08, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 141.08, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 141.08, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG ORG ID 6+", "code_information": [{"code": "86U", "type": "CPT"}], "standard_charges": [{"minimum": 180.0, "maximum": 180.0, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 180.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 180.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 180.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT QUAN ANTMCRB SC", "code_information": [{"code": "311U", "type": "CPT"}], "standard_charges": [{"minimum": 7.27, "maximum": 7.27, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 7.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 7.27, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 7.27, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT/VIRAL TRAIL IP10", "code_information": [{"code": "351U", "type": "CPT"}], "standard_charges": [{"minimum": 234.45, "maximum": 234.45, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 234.45, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 234.45, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 234.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV RNA VAG FLU ALG", "code_information": [{"code": "81513", "type": "CPT"}], "standard_charges": [{"minimum": 105.46, "maximum": 222.95, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 105.46, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage 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{"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 128.37, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 128.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS AMP PRB", "code_information": [{"code": "352U", "type": "CPT"}], "standard_charges": [{"minimum": 128.37, "maximum": 128.37, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 128.37, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 128.37, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 128.37, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV&VAGINITIS DNA ALG", "code_information": [{"code": "81514", "type": "CPT"}], 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"facility"}]}, {"description": "NFCT DS STRN TYP WHL GEN SEQ", "code_information": [{"code": "10U", "type": "CPT"}], "standard_charges": [{"minimum": 384.53, "maximum": 384.53, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 384.53, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 384.53, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 384.53, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 3 TRGT", "code_information": [{"code": "240U", "type": "CPT"}], "standard_charges": [{"minimum": 128.34, "maximum": 128.34, "setting": "outpatient", "payers_information": [{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 128.34, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 128.34, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 128.34, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS VIR RESP RNA 4 TRGT", "code_information": [{"code": "241U", "type": "CPT"}], "standard_charges": [{"minimum": 52.95, "maximum": 128.34, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 52.95, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 52.95, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 111.95, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 75.01, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 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146G COUCE NEEDLE", "code_information": [{"code": "90006219", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 173.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ADV BIO 4 INSERTION NEEDLE", "code_information": [{"code": "90006009", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 361.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ADV BIO 6 INSERTION NEEDLE", "code_information": [{"code": "90007727", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 154.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ADV BIO 7.6CM HEX WRENCH", "code_information": [{"code": "90011764", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 258.0, "discounted_cash": 154.8, 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CANNULA 10MM X 2CM", "code_information": [{"code": "90031907", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 99.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA 10MM X 3CM", "code_information": [{"code": "90010253", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 99.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA 12MM X 3CM", "code_information": [{"code": "90030219", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 148.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA 7MM X 7CM", "code_information": [{"code": "90004597", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 130.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA 8.25MM", "code_information": [{"code": "90004215", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 130.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA 8.25MM X 90MM", "code_information": [{"code": "90001793", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 77.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA GEMINI SR8", "code_information": [{"code": "90030613", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 165.0, "discounted_cash": 99.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA PARTIALLY THR", "code_information": [{"code": "90040259", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 79.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA PT 5.75MMX5CM", "code_information": [{"code": "90032064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 77.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA PT 7MM X 7CM", "code_information": [{"code": "90004596", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 217.0, "discounted_cash": 130.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX CANNULA TWIST IN", "code_information": [{"code": "90030207", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 132.0, "discounted_cash": 79.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT 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408.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX LIGAMENT REPAIR KIT", "code_information": [{"code": "90016825", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3731.0, "discounted_cash": 2238.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX LOBSTER CLAW", "code_information": [{"code": "90016221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 696.0, "discounted_cash": 417.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX MINI SUTURE HOOK", "code_information": [{"code": "90013098", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 370.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX MPL CANNULA ZN", "code_information": [{"code": "90031087", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 370.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX MPR CANNULA ZN", "code_information": [{"code": "90031086", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 370.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX NON-CANN DRILL 4MM", "code_information": [{"code": "90100089", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 483.0, "discounted_cash": 289.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX OATS DISPOS KIT 10MM", "code_information": [{"code": "90022262", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1887.0, "discounted_cash": 1132.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT 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"discounted_cash": 148.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX PERC INSERT KIT", "code_information": [{"code": "90019057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 614.0, "discounted_cash": 368.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX PORTAL SKID", "code_information": [{"code": "90031155", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 139.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX POWERPICK 45 DEG", "code_information": [{"code": "90040347", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 293.0, "discounted_cash": 175.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX PROFILE DRILL MINI FT", "code_information": [{"code": "90030570", 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"discounted_cash": 368.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX REAMER LOW PROFILE", "code_information": [{"code": "90040189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 361.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX REAMER LP", "code_information": [{"code": "90040374", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 361.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX RETRODRILL GUIDE ASSE", "code_information": [{"code": "90030214", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 598.0, "discounted_cash": 358.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT ARTHREX ROUND BURR 4.0X13", "code_information": [{"code": "90030200", 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ICONIX 2.3mm", "code_information": [{"code": "90040943", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 541.0, "discounted_cash": 324.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT DUAL LUMEN CATHETER", "code_information": [{"code": "90014967", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 229.0, "discounted_cash": 137.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT DYONICS 4.5 CANNULATED DRILL", "code_information": [{"code": "90004166", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 354.0, "discounted_cash": 212.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT EPIDURAL NEEDLE 14G X 6", "code_information": [{"code": "90006998", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 213.0, "discounted_cash": 127.8, "setting": 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"discounted_cash": 123.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT OSTEOMED .035MM X6 GUIDEWIRE", "code_information": [{"code": "90003959", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 106.0, "discounted_cash": 63.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT OSTEOMED .045 X 4 GUIDEWIRE", "code_information": [{"code": "90003963", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 232.0, "discounted_cash": 139.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT OSTEOMED .045 X 6 GUIDEWIRE", "code_information": [{"code": "90003964", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 129.0, "discounted_cash": 77.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT OSTEOMED 1.0MM DRILL", "code_information": [{"code": "90014366", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 351.0, "discounted_cash": 210.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT OSTEOMED 1.3MM DRILL J LATCH", "code_information": [{"code": "90013148", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 351.0, "discounted_cash": 210.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT OSTEOMED 1.3MM DRILL QUICK RE", "code_information": [{"code": "90013147", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 585.0, "discounted_cash": 351.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT OSTEOMED 1.5MM DRILL QUICK RE", "code_information": [{"code": "90012189", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 603.0, "discounted_cash": 361.8, "setting": "inpatient", "billing_class": 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K-WIRE", "code_information": [{"code": "90032142", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 112.0, "discounted_cash": 67.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 7MM OLIVE WIRE", "code_information": [{"code": "90007568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.0, "discounted_cash": 206.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 7MM OLIVE WIRE", "code_information": [{"code": "90031724", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 344.0, "discounted_cash": 206.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 BONE FENESTRATION PERFOR", "code_information": [{"code": "90031736", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 BT GUID ROD 3.0X550MM", "code_information": [{"code": "90032140", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 626.0, "discounted_cash": 375.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 COUNTERSINK HEAD 2.0MM", "code_information": [{"code": "90038002", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 313.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 COUNTERSINK HEAD 4.0MM", "code_information": [{"code": "90002295", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 313.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 COUNTERSINK HEAD 7.0MM", "code_information": [{"code": "90016476", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 313.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 COUNTERSINK HEAD 7.0MM", "code_information": [{"code": "90032684", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 522.0, "discounted_cash": 313.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 1.3X100MM", "code_information": [{"code": "90037805", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 1.6X110MM", "code_information": [{"code": "90031586", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.0X110MM", "code_information": [{"code": "90007565", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.0X110MM", "code_information": [{"code": "90031451", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.0X130MM", "code_information": [{"code": "90002288", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.1X120MM", "code_information": [{"code": "90022249", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.4 CANNULATED", "code_information": [{"code": "90031797", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 599.0, "discounted_cash": 359.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.4X140MM", "code_information": [{"code": "90031362", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.4X160MM", "code_information": [{"code": "90002246", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.4X180MM", "code_information": [{"code": "90002289", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 2.8 X160MM", "code_information": [{"code": "90016318", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 3.1X160MM", "code_information": [{"code": "90031737", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 3.5X110MM", "code_information": [{"code": "90032334", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 547.0, "discounted_cash": 328.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL BIT 3.6X160MM", "code_information": [{"code": "90031738", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL CANNULATED 1.7X120", "code_information": [{"code": "90004945", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL CANNULATED 2.3X120", "code_information": [{"code": "90013622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, "discounted_cash": 352.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT PG28 DRILL CANNULATED 2.6X130", "code_information": [{"code": "90031462", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 588.0, 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"inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N DRILL BIT QC LONG 3.5MM", "code_information": [{"code": "90001926", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 171.25, "discounted_cash": 102.75, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N DRILL SLEEVE INSERT", "code_information": [{"code": "90007958", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 394.0, "discounted_cash": 236.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N EXTREMITIES GUIDE", "code_information": [{"code": "90016550", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 247.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N FIRSTPASS MINI RIGHT", "code_information": [{"code": "90040221", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 531.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N FIRSTPASS MINILEFT", "code_information": [{"code": "90016545", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 531.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N FIRSTPASS SUTURE PASSER", "code_information": [{"code": "90100192", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 557.0, "discounted_cash": 334.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N FOOTPRINT MINI DRILL BIT", "code_information": [{"code": "90016558", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 577.0, "discounted_cash": 346.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N FOOTPRINT MINI DRILL BIT", "code_information": [{"code": "90016559", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 297.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N GENESIS PIN & DRILL SET", "code_information": [{"code": "90005985", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 528.0, "discounted_cash": 316.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N GUIDE PIN", "code_information": [{"code": "90015043", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 289.0, "discounted_cash": 173.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N GUIDE PIN 2.4 X 200MM", "code_information": [{"code": "90004318", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.92, "discounted_cash": 307.15, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N GUIDE PIN 2.4 X 230MM", "code_information": [{"code": "90001848", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 511.92, "discounted_cash": 307.15, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N GUIDE PIN 2.4 X 230MM", "code_information": [{"code": "90002783", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 145.0, "discounted_cash": 87.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N GUIDE PIN 3.2 MM", "code_information": [{"code": "90003626", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 575.0, "discounted_cash": 345.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N GUIDE PIN 3.2X230MM", "code_information": [{"code": "90017057", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 248.0, "discounted_cash": 148.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N GUIDE WIRE THD 3.2 TIP", "code_information": [{"code": "90003713", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 500.49, "discounted_cash": 300.29, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N INT HEXDRIVER MEDIUM", "code_information": [{"code": "90017058", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2462.0, "discounted_cash": 1477.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N K-WIRE", "code_information": [{"code": "90011718", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 162.0, "discounted_cash": 97.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT S&N K-WIRE 1.25MM", 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528.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SN DISP KIT FOR 2.8MM Q-FIX", "code_information": [{"code": "90015847", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 885.0, "discounted_cash": 531.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NONIMPLANT SN DRILL BIT 1.5MM", "code_information": [{"code": "90005134", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 520.0, "discounted_cash": 312.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SN DRILL BIT 1.5MM", "code_information": [{"code": "90017573", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1338.0, "discounted_cash": 802.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SN DRILL BIT 3.8 MM", "code_information": [{"code": "90004361", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 914.0, "discounted_cash": 548.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SN GEN UNIFEMOR COMPONENT LG", "code_information": [{"code": "90003235", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 7078.5, "discounted_cash": 4247.1, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SONOMA 2.0MM DRILL BIT", "code_information": [{"code": "90011294", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 264.0, "discounted_cash": 158.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SONOMA 4.5MM CANN DRILL BIT", "code_information": [{"code": "90011295", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 540.0, "discounted_cash": 324.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SONOMA 4.5MM 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309.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SPINAL ELEMENTS KARMA DRILL C", "code_information": [{"code": "90020185", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 773.0, "discounted_cash": 463.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SPINE WAVE BIOPSY NEEDLE*", "code_information": [{"code": "90017190", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 222.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SPINESMITH 5cc", "code_information": [{"code": "90016636", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1029.0, "discounted_cash": 617.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SPINESMITH 5cc", "code_information": [{"code": "90016645", "type": "CDM"}, {"code": "272", 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"billing_class": "facility"}]}, {"description": "NONIMPLANT SYN COUNTERSINK 3.5MM", "code_information": [{"code": "90019877", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 695.0, "discounted_cash": 417.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN DRILL GUIDE", "code_information": [{"code": "90009485", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1778.4, "discounted_cash": 1067.04, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN HOLLOW REAMER 1.5MM", "code_information": [{"code": "90015717", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1161.84, "discounted_cash": 697.1, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN HOLLOW REAMER 2.0MM", "code_information": [{"code": "90030374", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1370.52, "discounted_cash": 822.31, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN HOLLOW REAMER 2.7MM", "code_information": [{"code": "90015718", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1128.0, "discounted_cash": 676.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN HOLLOW REAMER 2.7MM", "code_information": [{"code": "90017962", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1128.0, "discounted_cash": 676.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN K-WIRE 1.6 X 150 MM NONTH", "code_information": [{"code": "90008874", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 187.0, "discounted_cash": 112.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN K-WIRE THD 1.6MM OLD***", "code_information": [{"code": "90002481", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 645.0, "discounted_cash": 387.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN NEEDLE 12G X 7.5CM NORIAN", "code_information": [{"code": "90010025", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 235.0, "discounted_cash": 141.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN NEEDLE 12G X 7.5CM NORIAN", "code_information": [{"code": "90015688", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 886.0, "discounted_cash": 531.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN NEEDLE 8G X 10CM", "code_information": [{"code": "90015317", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 297.0, "discounted_cash": 178.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN PROTECTIVE CAP 5.0", "code_information": [{"code": "90005219", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 31.0, "discounted_cash": 18.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN QC 110MM DRILL BIT 1.1MM", "code_information": [{"code": "90011706", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 592.0, "discounted_cash": 355.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN SCREWDRIVER 1.0MM", "code_information": [{"code": "90015527", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2551.5, "discounted_cash": 1530.9, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN SPARE REAMER TUBE", "code_information": [{"code": "90015603", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 783.0, "discounted_cash": 469.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN STARDRIVE DRIVER SHAFT", "code_information": [{"code": "90014089", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 1156.0, "discounted_cash": 693.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN THRD GUIDEWIRE 2.8 X 450", "code_information": [{"code": "90030365", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 465.3, "discounted_cash": 279.18, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN THRD GUIDEWIRE 25MMX230MM", "code_information": [{"code": "90008228", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 257.5, "discounted_cash": 154.5, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYN TRIPLE REAMER DHS COMPLET", "code_information": [{"code": "90009483", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 4076.8, "discounted_cash": 2446.08, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES", "code_information": [{"code": "90005216", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 29.96, "discounted_cash": 17.98, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.1MM DRILL BIT", "code_information": [{"code": "90009180", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 371.0, "discounted_cash": 222.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.3MM SCREW DRIVER", "code_information": [{"code": "90100229", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1629.0, "discounted_cash": 977.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.5MM SCREW DRIVER", "code_information": [{"code": "90100230", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1954.0, "discounted_cash": 1172.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.5MM THREAD DRILL GU", "code_information": [{"code": "90100280", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1703.0, "discounted_cash": 1021.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.6 HOLDING CLAMPS", "code_information": [{"code": "90003178", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3263.0, "discounted_cash": 1957.8, "setting": "both", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.6MM COMP WIRE 10MM", "code_information": [{"code": "90100240", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 350.15, "discounted_cash": 210.09, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.6MM COMP WIRE 15MM", "code_information": [{"code": "90011548", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 141.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.6MM COMP WIRE 2.0", "code_information": [{"code": "90010518", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 162.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.6MM COMP WIRE 25", "code_information": [{"code": "90010519", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 241.0, "discounted_cash": 144.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.6MM COMP WIRE40", "code_information": [{"code": "90016393", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 270.0, "discounted_cash": 162.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 1.8MM SH THR DRILL GU", "code_information": [{"code": "90007750", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 577.0, "discounted_cash": 346.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 110 X 2.8MM DRILL BIT", "code_information": [{"code": "90040940", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 315.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 12MM DRILL BIT", "code_information": [{"code": "90016618", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": 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"code_information": [{"code": "90020338", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 555.54, "discounted_cash": 333.32, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 2.8MM DRILL BIT", "code_information": [{"code": "90032400", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 608.0, "discounted_cash": 364.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 3.0 CONNECTING CLAMPS", "code_information": [{"code": "90003179", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 3030.0, "discounted_cash": 1818.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 3.5MM DRILL BIT", "code_information": [{"code": "90032378", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 303.0, "discounted_cash": 181.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES 3.5MM TAP SCREW", "code_information": [{"code": "90004940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.85, "discounted_cash": 491.31, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES ACCESS KIT 10GA", "code_information": [{"code": "90016953", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 618.0, "discounted_cash": 370.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES BIOPSY KIT", "code_information": [{"code": "90016954", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 330.0, "discounted_cash": 198.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES CANN REAMER DIST 20MM", "code_information": [{"code": "90020213", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 644.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES CANN REAMER DIST 20MM", "code_information": [{"code": "90040910", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 644.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES CANN REAMER DIST 22MM", "code_information": [{"code": "90040865", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 644.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES CANN REAMER DIST 24MM", "code_information": [{"code": "90014514", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 644.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES CANN REAMER DIST 24MM", "code_information": [{"code": "90014515", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 644.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES CANN REAMER PROX 20MM", "code_information": [{"code": "90040911", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 644.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES CANN REAMER PROX 22MM", "code_information": [{"code": "90040866", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1074.0, "discounted_cash": 644.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES COUNTERSINK", "code_information": [{"code": "90030144", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 488.0, "discounted_cash": 292.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT", "code_information": [{"code": "90003409", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1499.0, "discounted_cash": 899.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT", "code_information": [{"code": "90006610", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 881.0, "discounted_cash": 528.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.0 X 50 MM", "code_information": [{"code": "90003590", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 229.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.0MM", "code_information": [{"code": "90006122", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 346.0, "discounted_cash": 207.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.0MM", "code_information": [{"code": "90031304", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 241.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.0MM JL", "code_information": [{"code": "90031848", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.1MM", "code_information": [{"code": "90003955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 371.25, "discounted_cash": 222.75, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.1MM", "code_information": [{"code": "90030380", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 527.0, "discounted_cash": 316.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.1MM J", "code_information": [{"code": "90003956", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 384.0, "discounted_cash": 230.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.3 X 55MM", "code_information": [{"code": "90003591", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 229.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.3 X 55MM", "code_information": [{"code": "90015512", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.3MM", "code_information": [{"code": "90031469", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 356.0, "discounted_cash": 213.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.3MMx55MM", "code_information": [{"code": "90031605", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.5MM", "code_information": [{"code": "90006438", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 438.0, "discounted_cash": 262.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.5MM", "code_information": [{"code": "90008097", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 615.0, "discounted_cash": 369.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.5MM", "code_information": [{"code": "90011106", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 340.0, "discounted_cash": 204.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.5MM", "code_information": [{"code": "90031869", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.5MM", "code_information": [{"code": "90040661", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 179.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.5MM 110MM", "code_information": [{"code": "90011884", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 443.68, "discounted_cash": 266.21, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.5MM NS", "code_information": [{"code": "90003923", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 229.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.8MM", "code_information": [{"code": "90003273", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 454.0, "discounted_cash": 272.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 1.8MM", "code_information": [{"code": "90004658", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": 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"90008597", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 881.0, "discounted_cash": 528.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.0MM", "code_information": [{"code": "90001647", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 383.0, "discounted_cash": 229.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.0MM", "code_information": [{"code": "90003550", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 369.0, "discounted_cash": 221.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.0MM", "code_information": [{"code": "90006439", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 256.0, "discounted_cash": 153.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.5MM", "code_information": [{"code": "90001648", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 495.0, "discounted_cash": 297.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.5MM", "code_information": [{"code": "90012464", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1101.0, "discounted_cash": 660.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.5MM", "code_information": [{"code": "90012796", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1101.0, "discounted_cash": 660.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.5MM dia", "code_information": [{"code": "90009282", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 380.0, "discounted_cash": 228.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.7 MM", "code_information": [{"code": "90001649", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 466.0, "discounted_cash": 279.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 2.8x248MM", "code_information": [{"code": "90031568", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 561.0, "discounted_cash": 336.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 3.2", "code_information": [{"code": "90003601", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 239.0, "discounted_cash": 143.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 3.2", "code_information": [{"code": "90018507", 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{"description": "NONIMPLANT SYNTHES DRILL BIT 4.2", "code_information": [{"code": "90002846", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 524.0, "discounted_cash": 314.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 4.3MM", "code_information": [{"code": "90012354", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 745.0, "discounted_cash": 447.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 4.5 MM", "code_information": [{"code": "90009250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 359.0, "discounted_cash": 215.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 4.5 X 195MM", "code_information": [{"code": "90003220", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 560.0, "discounted_cash": 336.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 4.5MM", "code_information": [{"code": "90032675", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 745.0, "discounted_cash": 447.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 5.0MM", "code_information": [{"code": "90013131", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1790.0, "discounted_cash": 1074.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 5.0MM", "code_information": [{"code": "90018324", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1401.0, "discounted_cash": 840.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 6MM", "code_information": [{"code": "90010930", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 315.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 6MM", "code_information": [{"code": "90015574", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 612.0, "discounted_cash": 367.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT 8MM", "code_information": [{"code": "90031995", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 526.0, "discounted_cash": 315.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL BIT CANN 2.0MM", "code_information": [{"code": "90003245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1526.0, "discounted_cash": 915.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES DRILL GUIDE", "code_information": [{"code": "90020017", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 500.0, "discounted_cash": 300.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES EXTRACTION BOLT 2.0MM", "code_information": [{"code": "90100231", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 519.0, "discounted_cash": 311.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES EXTRACTION HOOK", "code_information": [{"code": "90020358", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1149.78, "discounted_cash": 689.87, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES GUIDE PIN", "code_information": [{"code": "90002586", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 152.0, "discounted_cash": 91.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES GUIDE WIRE 1.1 THREAD", "code_information": [{"code": "90003358", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 234.0, "discounted_cash": 140.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES GUIDE WIRE 1.25", "code_information": [{"code": "90002075", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 175.0, "discounted_cash": 105.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES GUIDEWIRE 0.8MM X 100", "code_information": [{"code": "90030004", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 111.0, "discounted_cash": 66.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES INFLATION SYSTEM", "code_information": [{"code": "90016955", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 412.0, "discounted_cash": 247.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES INSERTER TIP XL 5MM", "code_information": [{"code": "90016097", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 460.8, "discounted_cash": 276.48, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES J-LATCH", "code_information": [{"code": "90040900", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 453.0, "discounted_cash": 271.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES J-LATCH FOR THREADED", "code_information": [{"code": "90040254", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES JLATCH 1.1MM", "code_information": [{"code": "90032211", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 527.0, "discounted_cash": 316.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES JLATCH 1.5MM", "code_information": [{"code": "90032212", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 403.0, "discounted_cash": 241.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES K-WIRE .06X70MM", "code_information": [{"code": "90005626", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 352.0, "discounted_cash": 211.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES K-WIRE .08X70MM", "code_information": [{"code": "90005627", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": 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[{"code": "90040250", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 396.0, "discounted_cash": 237.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES PLATE 2.4MM VA-LCP DR", "code_information": [{"code": "90015404", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 662.0, "discounted_cash": 397.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES REAM ROD", "code_information": [{"code": "90015988", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1150.0, "discounted_cash": 690.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES ROD TEMPLATE 240MM", "code_information": [{"code": "90021804", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 818.85, "discounted_cash": 491.31, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SCREW & PLATE FORCEPS", "code_information": [{"code": "90031864", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1121.0, "discounted_cash": 672.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SCREW DRIVER HEX HAND", "code_information": [{"code": "90031865", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3352.0, "discounted_cash": 2011.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SCREW DRIVER T4", "code_information": [{"code": "90040291", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1553.0, "discounted_cash": 931.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SCREWDRIVER LG HEX", "code_information": [{"code": "90040898", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 299.0, "discounted_cash": 179.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SCREWDRIVER SHAFT", "code_information": [{"code": "90040944", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1714.0, "discounted_cash": 1028.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SCREWDRIVER SM HEX", "code_information": [{"code": "90040578", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 225.0, "discounted_cash": 135.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SCREWDRIVER TIP T8", "code_information": [{"code": "90030407", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1784.0, "discounted_cash": 1070.4, "setting": "both", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SLEEVE", "code_information": [{"code": "90030683", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 555.54, "discounted_cash": 333.32, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES SPEED COMP GUIDE", "code_information": [{"code": "90032224", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 251.0, "discounted_cash": 150.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES STAR DRIVER", "code_information": [{"code": "90030855", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1196.0, "discounted_cash": 717.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES STEPPED DRILL BIT", "code_information": [{"code": "90019622", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2011.41, "discounted_cash": 1206.85, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES TEMP FIX PIN", "code_information": [{"code": "90010550", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 529.0, "discounted_cash": 317.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES VERTECEM II SYR KIT", "code_information": [{"code": "90016976", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 577.0, "discounted_cash": 346.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SYNTHES WASHER SPIKED 13.5/4.", "code_information": [{"code": "90017082", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 174.0, "discounted_cash": 104.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT SZ6 TIBIAL TEMPLATE", "code_information": [{"code": "90031471", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 464.0, "discounted_cash": 278.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TAP 3.2MM AO", "code_information": [{"code": "90022300", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 515.0, "discounted_cash": 309.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TARGET NEEDLE 11G", "code_information": [{"code": "90011631", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 359.0, "discounted_cash": 215.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TEN20 BLUNT K-WIRE", "code_information": [{"code": "90009772", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 420.0, "discounted_cash": 252.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TEN20 DRILL BIT", "code_information": [{"code": "90008195", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 570.0, "discounted_cash": 342.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TEN20 TARGETING NEEDLE", "code_information": [{"code": "90007419", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 810.0, "discounted_cash": 486.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TENEX TX1 PROCEDURE PACK", "code_information": [{"code": "90040245", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2049.0, "discounted_cash": 1229.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TLA 1.27MM SAW BLADE", "code_information": [{"code": "90006573", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 236.0, "discounted_cash": 141.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TM PLATE DISPOS", "code_information": [{"code": "90011396", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2260.0, "discounted_cash": 1356.0, "setting": "both", "billing_class": "facility"}]}, {"description": "NONIMPLANT TOBRA FEATHER FLOW", "code_information": [{"code": "90016387", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 150.0, "discounted_cash": 90.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TORNEIR ARTHROTUNNELER", "code_information": [{"code": "90009899", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1785.0, "discounted_cash": 1071.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT TORNIER 2.0 PIN K-WIRE", "code_information": [{"code": "90012793", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 135.0, 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"setting": "both", "billing_class": "facility"}]}, {"description": "NONIMPLANT WRIGHT", "code_information": [{"code": "90008762", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 1950.0, "discounted_cash": 1170.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT WRIGHT 1.2 K-WIRE", "code_information": [{"code": "90016158", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 176.0, "discounted_cash": 105.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT WRIGHT 1.6MM HEX DRIVER", "code_information": [{"code": "90015566", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"gross_charge": 770.0, "discounted_cash": 462.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "NONIMPLANT WRIGHT 2.0 DRILL BIT", "code_information": [{"code": "90014439", "type": "CDM"}, {"code": "272", "type": "RC"}], 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{"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1792.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1792.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/EXPLORATION", "code_information": [{"code": "50120", "type": "CPT"}], "standard_charges": [{"minimum": 1792.0, "maximum": 7101.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1792.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1792.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYELOTOMY W/REMOVAL CALCULUS", "code_information": [{"code": "50130", "type": "CPT"}], "standard_charges": [{"minimum": 1792.0, "maximum": 7101.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 3359.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 6746.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 6390.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 7101.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 4758.0, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 1792.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 1792.0, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 1792.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "PYRIDOXINE (VIT B6) TAB : 50MG", "code_information": [{"code": "3510561", "type": "CDM"}, {"code": "250", "type": "RC"}], "standard_charges": [{"gross_charge": 6.0, "discounted_cash": 3.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With MCC Or 4+ Arteries Or Stents", "code_information": [{"code": "246", "type": "MS-DRG"}], "standard_charges": [{"minimum": 17648.9, "maximum": 28606.07, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 17648.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 17648.9, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 28606.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 27177.26, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 19167.56, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 25745.46, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 19167.56, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 19167.56, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 28606.07, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 19167.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without MCC", "code_information": [{"code": "247", "type": "MS-DRG"}], "standard_charges": [{"minimum": 11250.77, "maximum": 18235.73, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 11250.77, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 11250.77, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 18235.73, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 17324.89, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 12218.89, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 16412.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 12218.89, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 12218.89, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", 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{"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 19259.71, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 25869.23, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 19259.71, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 19259.71, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 28743.59, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 19259.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without MCC", "code_information": [{"code": "249", "type": "MS-DRG"}], "standard_charges": [{"minimum": 10704.0, "maximum": 17349.49, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 10704.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 10704.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 17349.49, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 16482.92, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 11625.06, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 15614.54, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 11625.06, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 11625.06, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", 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"standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 70.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Phospholipase A2 Receptor Antibodies", "code_information": [{"code": "86255", "type": "CPT"}, {"code": "3000990", "type": "CDM"}, 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{"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 147.67, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 98.94, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 12.05, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 12.05, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 12.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Potassium, Serum", "code_information": [{"code": "84132", "type": "CPT"}, {"code": "3000992", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 4.6, "maximum": 50.76, "gross_charge": 55.0, "discounted_cash": 33.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", 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"United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 4.6, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 4.6, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 4.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Procedures on the Palate and Uvula", "code_information": [{"code": "42100", "type": "CPT"}, {"code": "1002073", "type": "CDM"}, {"code": "360", "type": "RC"}], "standard_charges": [{"minimum": 1376.18, "maximum": 3361.0, "gross_charge": 2845.0, "discounted_cash": 1707.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 1590.0, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", 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FINGER CONTROL LL TIP 12CC", "code_information": [{"code": "90000217", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 18.0, "discounted_cash": 10.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR FINGER CONTROL LL TIP 20CC", "code_information": [{"code": "90000218", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 14.0, "discounted_cash": 8.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR GROUT GRABBER BLUE", "code_information": [{"code": "90006922", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 39.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR GROUT GRABBER RED", "code_information": [{"code": "90007611", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 66.0, "discounted_cash": 39.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR INJECTOR OPEN MRI", "code_information": [{"code": "90012401", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 107.0, "discounted_cash": 64.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR INS 1CC SAFETYGLIDE 305930", "code_information": [{"code": "80000208", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR INSULIN 1/2CC, 29GX1/2 NEEDLE", "code_information": [{"code": "90001589", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 2.49, "discounted_cash": 1.49, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR INSULIN 1C W/NEEDLE", "code_information": [{"code": "90000709", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR MONOJECT 60CC TOOMEY TIP", "code_information": [{"code": "90015998", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR ONLY 60 ML LUER-LOK", "code_information": [{"code": "80004807", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 4.0, "discounted_cash": 2.4, "setting": "both", "billing_class": "facility"}]}, {"description": "SYR ONLY 60 ML LUER-LOK", "code_information": [{"code": "90000611", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR QWIK-FIT FOR SOLARIS INJECTION SYSTE", "code_information": [{"code": "90006513", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 76.0, "discounted_cash": 45.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR TB 26G X 3/8 305946", "code_information": [{"code": "80000145", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR TB 27G X 1/2 305945", "code_information": [{"code": "80000288", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 3.0, "discounted_cash": 1.8, "setting": "both", "billing_class": "facility"}]}, {"description": "SYR TB REG L/L 1CC (USE 80000524)", "code_information": [{"code": "90000925", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 2.0, "discounted_cash": 1.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR TB W/DETACH NEEDLE SLIP TIP 309624", "code_information": [{"code": "90000885", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR TB WITH DETACHABLE NEEDLE SLIP TIP", "code_information": [{"code": "90011410", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYR TB WITH INTRADERMAL BEVEL", "code_information": [{"code": "90000538", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYRINGE 10ML SALINE 30 PER BX", "code_information": [{"code": "80050123", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE 10ML SALINE 30 PER BX", "code_information": [{"code": "90030493", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE 35CC LUER LOCK 81-535762", "code_information": [{"code": "80001016", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE 3ML ORAL MEDICATION", "code_information": [{"code": "90014302", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYRINGE 5ML SALINE / PAIN MANAGEMENT", "code_information": [{"code": "80050124", "type": "CDM"}, {"code": "270", "type": "RC"}], "standard_charges": [{"gross_charge": 7.0, "discounted_cash": 4.2, "setting": "both", "billing_class": "facility"}]}, {"description": "SYRINGE 5ML SLIP TIP", "code_information": [{"code": "90005395", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.62, "discounted_cash": 0.37, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYRINGE ORAL MEDICATION", "code_information": [{"code": "90014303", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 1.0, "discounted_cash": 0.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYRINGE SLIP TIP 3ML", "code_information": [{"code": "90005396", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"gross_charge": 0.51, "discounted_cash": 0.31, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYRUP CHERRY SYRUP SOLN PER ML", "code_information": [{"code": "A9270", "type": "HCPCS"}, {"code": "3510090", "type": "CDM"}, {"code": "637", "type": "RC"}], "standard_charges": [{"gross_charge": 5.0, "discounted_cash": 3.0, "setting": "inpatient", "billing_class": "facility"}], "modifiers": "GY"}, {"description": "SYRUP PANCAKE & WAFFLE 2% MAPLE", "code_information": [{"code": "90011943", "type": "CDM"}, {"code": "271", "type": "RC"}], "standard_charges": [{"gross_charge": 71.0, "discounted_cash": 42.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYSMEX C 1000 CALIBRATOR", "code_information": [{"code": "90006918", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 167.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYSMEX CELLPACK 20L", "code_information": [{"code": "90005061", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 180.0, "discounted_cash": 108.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYSMEX E-CHECK ((XS) 5X1.5MLX1 LOW", "code_information": [{"code": "90005063", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 590.0, "discounted_cash": 354.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYSMEX E-CHECK (XS) 1.5MLX2 NORMAL/HIGH", "code_information": [{"code": "90005064", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 920.0, "discounted_cash": 552.0, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYSMEX FILTER ASSY FOR RINSE BOTTLE", "code_information": [{"code": "90065482", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 279.0, "discounted_cash": 167.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYSMEX STROMATOLYSER 4 DL 5 L", "code_information": [{"code": "90005059", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 448.0, "discounted_cash": 268.8, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYSMEX STROMATOLYSER 4 DS 42MLX3", "code_information": [{"code": "90005060", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 961.0, "discounted_cash": 576.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "SYSMEX SULFOLYSER", "code_information": [{"code": "90005062", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 387.0, "discounted_cash": 232.2, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "Services provided in an UC center", "code_information": [{"code": "S9088", "type": "HCPCS"}, {"code": "2100271", "type": "CDM"}, {"code": "526", "type": "RC"}], "standard_charges": [{"gross_charge": 26.0, "discounted_cash": 15.6, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "Sirolimus", "code_information": [{"code": "80195", "type": "CPT"}, {"code": "3000991", "type": "CDM"}, {"code": "300", "type": "RC"}], "standard_charges": [{"minimum": 13.73, "maximum": 218.64, "gross_charge": 100.0, "discounted_cash": 60.0, "setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 103.41, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 103.41, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 218.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 146.49, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 196.78, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 146.49, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 146.49, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 218.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 146.49, "methodology": "fee schedule"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 13.73, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 13.73, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 13.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Specialty Services Observation Hours", "code_information": [{"code": "762", "type": "RC"}], "standard_charges": [{"setting": "outpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3500.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 3500.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 74.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 35.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 67.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HMH", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "HPN", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "PPO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 74.0, "count": "0", "methodology": "percent of total billed charges"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "additional_payer_notes": "No historical data found for payer/plan and coding combination", "standard_charge_percentage": 34.0, "count": "0", "methodology": "percent of total billed charges"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion Except Cervical With MCC", "code_information": [{"code": "459", "type": "MS-DRG"}], "standard_charges": [{"minimum": 39081.64, "maximum": 63345.15, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 39081.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 39081.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 63345.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 60181.21, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 42444.57, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 57010.64, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 42444.57, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 42444.57, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 44969.57, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 63345.15, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 42444.57, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 44541.29, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 57031.15, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 57031.15, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 44541.29, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 57031.15, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Spinal Fusion Except Cervical Without MCC", "code_information": [{"code": "460", "type": "MS-DRG"}], "standard_charges": [{"minimum": 22189.27, "maximum": 35965.3, "estimated_discounted_cash": 74922.72, "setting": "inpatient", "payers_information": [{"payer_name": "BCBS", "plan_name": "BAV", "standard_charge_dollar": 22189.27, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Advantage HMO", "standard_charge_dollar": 22189.27, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Choice", "standard_charge_dollar": 35965.3, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Essentials HMO", "standard_charge_dollar": 34168.92, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Blue Health", "standard_charge_dollar": 24098.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "City of Dallas PPO", "standard_charge_dollar": 32368.77, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HMH", "standard_charge_dollar": 24098.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "HPN", "standard_charge_dollar": 24098.63, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Medicare Adv HMO", "standard_charge_dollar": 24801.98, "methodology": "case rate"}, {"payer_name": "BCBS", "plan_name": "PPO", "standard_charge_dollar": 35965.3, "methodology": "fee schedule"}, {"payer_name": "BCBS", "plan_name": "Premier HMO", "standard_charge_dollar": 24098.63, "methodology": "fee schedule"}, {"payer_name": "Health First", "plan_name": "TPA", "standard_charge_dollar": 24565.77, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Charter", "standard_charge_dollar": 31454.28, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Commercial", "standard_charge_dollar": 31454.28, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "MCR Advantage", "standard_charge_dollar": 24565.77, "methodology": "case rate"}, {"payer_name": "United HealthCare", "plan_name": "Nexus", "standard_charge_dollar": 31454.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "Sterile HD Split Surgical Drape, 88 x 1", "code_information": [{"code": "90024560", "type": "CDM"}, {"code": "272", "type": "RC"}], "standard_charges": [{"gross_charge": 219.0, "discounted_cash": 131.4, "setting": "inpatient", "billing_class": "facility"}]}, {"description": "T CELL ABSOLUTE COUNT", 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