{"hospital_name": "Fresno Surgical Hospital", "last_updated_on": "2026-04-08", "version": "3.0.0", "pid": "1549980701", "rid": "11842", "location_name": ["Fresno Surgical Hospital"], "hospital_address": ["6125 N Fresno St, Fresno, CA 93710"], "type_2_npi": ["1205834694"], "license_information": {"license_number": "040000332", "state": "CA"}, "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": "\"\"Y SET\"\" TUBING", "code_information": [{"code": "A4719", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.13, "maximum": 15.13, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 15.13, "methodology": "fee schedule"}], "billing_class": 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18.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "11MM BAR X 250MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "278038875", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 520.45, "maximum": 520.45, "gross_charge": 705.0, "estimated_discounted_cash": 3582.22, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 520.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "11MM BAR X 300MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "278038605", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 520.45, "maximum": 520.45, "gross_charge": 720.0, "estimated_discounted_cash": 3582.22, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 520.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "11MM BAR X 350MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "278038606", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 520.45, "maximum": 520.45, "gross_charge": 753.2, "estimated_discounted_cash": 3582.22, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 520.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "17817000 PATELLAR HEMI LIG", "code_information": [{"code": "C1762", "type": "HCPCS"}, {"code": "278032725", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2208.62, "maximum": 2208.62, "gross_charge": 7362.5, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2208.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS HIGH 75", "code_information": [{"code": "99223", "type": "CPT"}], "standard_charges": [{"minimum": 80.1, "maximum": 80.1, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 80.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS MODERATE 55", "code_information": [{"code": "99222", "type": "CPT"}], "standard_charges": [{"minimum": 73.2, "maximum": 73.2, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 73.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST HOSP IP/OBS SF/LOW 40", "code_information": [{"code": "99221", "type": "CPT"}], "standard_charges": [{"minimum": 34.3, "maximum": 34.3, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 34.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE HIGH MDM 50", "code_information": [{"code": "99306", "type": "CPT"}], "standard_charges": [{"minimum": 162.85, "maximum": 162.85, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 162.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE MODERATE MDM 35", "code_information": [{"code": "99305", "type": "CPT"}], "standard_charges": [{"minimum": 119.09, "maximum": 119.09, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 119.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST NF CARE SF/LOW MDM 25", "code_information": [{"code": "99304", "type": "CPT"}], "standard_charges": [{"minimum": 71.93, "maximum": 71.93, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 71.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "1ST PLMT DRUG ELUT OC INS", "code_information": [{"code": "444T", "type": "CPT"}], "standard_charges": [{"minimum": 2807.0, "maximum": 3502.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3502.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "1ST PSYC COLLAB CARE MGMT", "code_information": [{"code": "99492", "type": "CPT"}], "standard_charges": [{"minimum": 113.93, "maximum": 141.26, "discounted_cash": 177.41, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 141.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", 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[{"code": "G9877", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.0, "maximum": 12.0, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 10-12 WL", "code_information": [{"code": "G9879", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.0, "maximum": 48.0, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 NO WL", "code_information": [{"code": "G9876", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.0, "maximum": 12.0, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 12.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM CORE MS MO 7-9 WL", "code_information": [{"code": "G9878", "type": "HCPCS"}], "standard_charges": [{"minimum": 48.0, "maximum": 48.0, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 48.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 13-15 WL", "code_information": [{"code": "G9882", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.0, "maximum": 40.0, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 40.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2 EM ONGOING MS MO 16-18 WL", "code_information": [{"code": "G9883", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.0, "maximum": 40.0, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 40.0, 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PHOTO IMAGE", "code_information": [{"code": "D0703", "type": "HCPCS"}], "standard_charges": [{"minimum": 116.15, "maximum": 119.22, "discounted_cash": 151.97, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 116.15, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 119.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [{"code": "C8925", "type": "HCPCS"}], "standard_charges": [{"minimum": 777.95, "maximum": 1050.42, "discounted_cash": 1368.95, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1023.41, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1050.42, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": 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1817.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3.5MM LCP 4 HOLE PLATE 50MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "278027636", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 520.45, "maximum": 520.45, "gross_charge": 1125.45, "estimated_discounted_cash": 3582.22, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 520.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "3.5MM PLATE 4H 93MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "278012600", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 520.45, "maximum": 520.45, "gross_charge": 3608.0, "estimated_discounted_cash": 3582.22, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 520.45, "methodology": "fee 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{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 20.06, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 20.59, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "AMINO ACIDS SINGLE QUANT", "code_information": [{"code": "82131", "type": "CPT"}], "standard_charges": [{"minimum": 18.36, "maximum": 24.13, "discounted_cash": 41.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 19.7, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 18.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 23.51, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", 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"payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 50.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES INCOMPL/MISSED AB PX", "code_information": [{"code": "1965", "type": "CPT"}], "standard_charges": [{"minimum": 61.59, "maximum": 61.59, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 61.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES INDUCED ABORTION PX", "code_information": [{"code": "1966", "type": "CPT"}], "standard_charges": [{"minimum": 61.59, "maximum": 61.59, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 61.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES IPER UPR ABD GSTR PX MO", "code_information": [{"code": "797", "type": "CPT"}], 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"maximum": 189.84, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 189.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES SPINE TRANTHOR W/O VENT", "code_information": [{"code": "625", "type": "CPT"}], "standard_charges": [{"minimum": 164.48, "maximum": 164.48, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 164.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD ARTRL", "code_information": [{"code": "1924", "type": "CPT"}], "standard_charges": [{"minimum": 63.33, "maximum": 63.33, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 63.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD CARD", "code_information": [{"code": "1925", "type": "CPT"}], "standard_charges": [{"minimum": 88.54, "maximum": 88.54, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 88.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD TIPS", "code_information": [{"code": "1931", "type": "CPT"}], "standard_charges": [{"minimum": 88.54, "maximum": 88.54, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 88.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES THER INTERVEN RAD VEIN", "code_information": [{"code": "1930", "type": "CPT"}], "standard_charges": [{"minimum": 63.33, "maximum": 63.33, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 63.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD CRAN VEIN", "code_information": [{"code": "1933", "type": "CPT"}], "standard_charges": [{"minimum": 88.54, "maximum": 88.54, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 88.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD HRT/CRAN", "code_information": [{"code": "1926", "type": "CPT"}], "standard_charges": [{"minimum": 101.15, "maximum": 101.15, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 101.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES TX INTERV RAD TH VEIN", "code_information": [{"code": "1932", "type": "CPT"}], "standard_charges": [{"minimum": 75.93, "maximum": 75.93, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": 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"standard_charges": [{"minimum": 77.11, "maximum": 77.11, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 77.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANES/ANALG CS DLVR NEURAXIAL", "code_information": [{"code": "1968", "type": "CPT"}], "standard_charges": [{"minimum": 30.88, "maximum": 30.88, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 30.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMEN VESSEL SURG", "code_information": [{"code": "880", "type": "CPT"}], "standard_charges": [{"minimum": 189.84, "maximum": 189.84, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 189.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "700", "type": "CPT"}], "standard_charges": [{"minimum": 37.97, "maximum": 37.97, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 37.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "730", "type": "CPT"}], "standard_charges": [{"minimum": 63.33, "maximum": 63.33, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 63.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ANESTH ABDOMINAL WALL SURG", "code_information": [{"code": "800", "type": "CPT"}], "standard_charges": [{"minimum": 37.97, "maximum": 37.97, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 37.97, "methodology": "fee 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{"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4.83, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4.6, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD FATTY ACIDS", "code_information": [{"code": "82725", "type": "CPT"}], "standard_charges": [{"minimum": 14.5, "maximum": 19.71, "discounted_cash": 34.08, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 15.55, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 14.5, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 19.2, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 19.71, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BLOOD LIPOPROTEIN", "code_information": [{"code": "83719", "type": "CPT"}], "standard_charges": [{"minimum": 10.34, "maximum": 13.39, "discounted_cash": 23.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 12.18, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 13.04, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 13.39, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY 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{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4.62, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4.75, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 4.52, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF BRADYKININ", "code_information": [{"code": "82286", "type": "CPT"}], "standard_charges": [{"minimum": 4.58, "maximum": 8.04, "discounted_cash": 9.37, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 8.04, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.58, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 5.28, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": 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{"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4.18, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PHENYTOIN FREE", "code_information": [{"code": "80186", "type": "CPT"}], "standard_charges": [{"minimum": 12.23, "maximum": 16.08, "discounted_cash": 24.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 12.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 14.08, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 14.45, "methodology": "fee schedule"}, {"payer_name": "Untied 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"plan_name": "HMO", "standard_charge_dollar": 22.1, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21.05, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PREGNENOLONE", "code_information": [{"code": "84140", "type": "CPT"}], "standard_charges": [{"minimum": 18.38, "maximum": 24.15, "discounted_cash": 37.53, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 18.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 21.15, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 21.7, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", 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"standard_charge_dollar": 28.02, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 26.69, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROLACTIN", "code_information": [{"code": "84146", "type": "CPT"}], "standard_charges": [{"minimum": 17.11, "maximum": 22.63, "discounted_cash": 35.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 22.63, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 17.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 19.83, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 20.35, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 19.38, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROSTAGLANDIN", "code_information": [{"code": "84150", "type": "CPT"}], "standard_charges": [{"minimum": 27.17, "maximum": 43.86, "discounted_cash": 75.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 29.15, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 27.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 42.73, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 43.86, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 41.77, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROTEIN ANY SOURCE", "code_information": [{"code": "84160", "type": "CPT"}], "standard_charges": [{"minimum": 4.6, "maximum": 6.04, "discounted_cash": 10.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 6.04, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 5.74, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 5.89, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 5.61, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PROTEIN OTHER", "code_information": [{"code": "84157", "type": "CPT"}], "standard_charges": [{"minimum": 2.99, "maximum": 4.28, "discounted_cash": 7.26, "setting": "outpatient", "payers_information": 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"methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3.85, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 3.67, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PSA COMPLEXED", "code_information": [{"code": "84152", "type": "CPT"}], "standard_charges": [{"minimum": 16.35, "maximum": 21.49, "discounted_cash": 33.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 21.49, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 16.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 18.81, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18.39, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF PSA FREE", "code_information": [{"code": "84154", "type": "CPT"}], "standard_charges": [{"minimum": 12.87, "maximum": 21.49, "discounted_cash": 33.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 21.49, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 12.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 18.81, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 19.31, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18.39, "methodology": "case rate"}], "billing_class": 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"standard_charge_dollar": 14.42, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 13.73, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SOMATOMEDIN", "code_information": [{"code": "84305", "type": "CPT"}], "standard_charges": [{"minimum": 18.39, "maximum": 22.32, "discounted_cash": 38.6, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 21.48, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 18.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 21.75, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 22.32, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 21.26, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SOMATOSTATIN", "code_information": [{"code": "84307", "type": "CPT"}], "standard_charges": [{"minimum": 16.25, "maximum": 21.36, "discounted_cash": 33.19, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 21.36, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 16.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 18.7, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 19.19, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 18.28, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF SWEAT SODIUM", 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"standard_charge_dollar": 16.86, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 16.06, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "ASSAY OF THYROID (T3 OR T4)", "code_information": [{"code": "84479", "type": "CPT"}], "standard_charges": [{"minimum": 5.68, "maximum": 7.56, "discounted_cash": 11.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.68, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 6.79, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", 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13.28, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 13.63, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 12.98, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "CLOT FACTOR IX PTC/CHRSTMAS", "code_information": [{"code": "85250", "type": "CPT"}], "standard_charges": [{"minimum": 16.93, "maximum": 22.24, "discounted_cash": 34.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 22.24, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 16.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 19.48, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 19.99, "methodology": "fee 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"methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W/O & W/DYE", "code_information": [{"code": "74170", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 366.59, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 366.59, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 237.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ABDOMEN W/O DYE", "code_information": [{"code": "74150", "type": 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{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 351.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 491.55, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 504.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO ABDOM W/O & W/DYE", "code_information": [{"code": "74175", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 392.47, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 392.47, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 277.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO ABDOMINAL ARTERIES", "code_information": [{"code": "75635", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 414.15, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 414.15, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 342.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO HRT W/3D IMAGE", "code_information": [{"code": "75574", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 335.53, "discounted_cash": 609.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 335.53, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 312.13, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO LWR EXTR W/O&W/DYE", "code_information": [{"code": "73706", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 392.32, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 392.32, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 316.03, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIO UPR EXTRM W/O&W/DYE", "code_information": [{"code": "73206", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 387.96, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 387.96, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 291.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPH PELV W/O&W/DYE", "code_information": [{"code": "72191", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 388.28, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 388.28, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 274.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPHY CHEST", "code_information": [{"code": "71275", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 392.9, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 392.9, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 270.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT ANGIOGRAPHY HEAD", "code_information": [{"code": "70496", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 385.89, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 385.89, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 266.02, "methodology": "fee 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"facility"}]}, {"description": "CT BONE DENSITY AXIAL", "code_information": [{"code": "77078", "type": "CPT"}], "standard_charges": [{"minimum": 75.05, "maximum": 119.22, "discounted_cash": 151.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 75.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 116.15, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 119.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C+", "code_information": [{"code": "637T", "type": "CPT"}], "standard_charges": [{"minimum": 491.55, "maximum": 504.53, "discounted_cash": 609.24, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 491.55, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 504.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-", "code_information": [{"code": "636T", "type": "CPT"}], "standard_charges": [{"minimum": 313.2, "maximum": 321.47, "discounted_cash": 416.67, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 313.2, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 321.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D BI C-/C+", "code_information": [{"code": "638T", "type": "CPT"}], "standard_charges": [{"minimum": 491.55, "maximum": 504.53, "discounted_cash": 609.24, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 491.55, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 504.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C+", "code_information": [{"code": "634T", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 241.04, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-", "code_information": [{"code": "633T", "type": "CPT"}], "standard_charges": [{"minimum": 140.52, "maximum": 144.23, "discounted_cash": 182.57, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 140.52, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 144.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT BREAST W/3D UNI C-/C+", "code_information": [{"code": "635T", "type": "CPT"}], "standard_charges": [{"minimum": 234.84, "maximum": 241.04, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST SPINE W/DYE", "code_information": [{"code": "72129", "type": "CPT"}], "standard_charges": [{"minimum": 164.34, "maximum": 282.69, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 282.69, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 164.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT CHEST SPINE W/O & W/DYE", "code_information": [{"code": "72130", "type": "CPT"}], "standard_charges": [{"minimum": 193.14, "maximum": 342.69, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 342.69, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 193.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", 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"standard_charge_dollar": 468.71, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT COLONOGRAPHY SCREENING", "code_information": [{"code": "74263", "type": "CPT"}], "standard_charges": [{"minimum": 694.4, "maximum": 779.49, "discounted_cash": 416.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 694.4, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 779.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT GUIDE FOR TISSUE ABLATION", "code_information": [{"code": "77013", "type": "CPT"}], "standard_charges": [{"minimum": 160.82, "maximum": 498.63, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 498.63, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 160.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT HEAD/BRAIN W/DYE", "code_information": [{"code": "70460", "type": "CPT"}], "standard_charges": [{"minimum": 142.83, "maximum": 241.04, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 232.73, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 142.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee 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{"description": "CT HRT W/O DYE W/CA TEST", "code_information": [{"code": "75571", "type": "CPT"}], "standard_charges": [{"minimum": 66.52, "maximum": 119.22, "discounted_cash": 151.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 66.52, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 81.33, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 116.15, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 119.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXTREMITY W/DYE", "code_information": [{"code": "73701", "type": "CPT"}], "standard_charges": [{"minimum": 161.28, "maximum": 274.71, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 274.71, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 161.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT LOWER EXTREMITY W/O DYE", "code_information": [{"code": "73700", "type": "CPT"}], "standard_charges": [{"minimum": 124.34, "maximum": 221.45, "discounted_cash": 182.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 221.45, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 124.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", 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234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT MAXILLOFACIAL W/DYE", "code_information": [{"code": "70487", "type": "CPT"}], "standard_charges": [{"minimum": 146.65, "maximum": 287.22, "discounted_cash": 306.31, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 287.22, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 146.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT MAXILLOFACIAL W/O & W/DYE", "code_information": [{"code": 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{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 234.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 241.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "CT PELVIS W/O DYE", "code_information": [{"code": "72192", "type": "CPT"}], "standard_charges": [{"minimum": 127.59, "maximum": 220.66, "discounted_cash": 182.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 220.66, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 127.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 140.52, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 144.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, 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"standard_charge_dollar": 63.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 117.06, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 120.15, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 114.43, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 15-21 CLASSES", "code_information": [{"code": "G0482", "type": "HCPCS"}], "standard_charges": [{"minimum": 132.82, "maximum": 208.68, "discounted_cash": 360.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 137.8, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 132.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 203.31, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 208.68, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 198.74, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 22+ CLASSES", "code_information": [{"code": "G0483", "type": "HCPCS"}], "standard_charges": [{"minimum": 172.18, "maximum": 259.27, "discounted_cash": 448.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 178.64, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 172.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 252.6, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 259.27, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 246.92, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "DRUG TEST DEF 8-14 CLASSES", "code_information": [{"code": "G0481", "type": "HCPCS"}], "standard_charges": [{"minimum": 98.39, "maximum": 164.42, "discounted_cash": 284.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 102.08, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 98.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 160.19, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 164.42, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", 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OF ABDOMEN", "code_information": [{"code": "76705", "type": "CPT"}], "standard_charges": [{"minimum": 60.74, "maximum": 144.23, "discounted_cash": 182.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 96.71, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 60.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 140.52, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 144.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF EYE", "code_information": [{"code": "76516", "type": "CPT"}], "standard_charges": [{"minimum": 42.29, "maximum": 144.23, "discounted_cash": 182.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", 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{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 247.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 705.13, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 723.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO EXAM OF FETAL HEART", "code_information": [{"code": "76826", "type": "CPT"}], "standard_charges": [{"minimum": 113.09, "maximum": 321.47, "discounted_cash": 416.67, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 113.09, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 148.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 313.2, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", 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HEART BIOPSY", "code_information": [{"code": "76932", "type": "CPT"}], "standard_charges": [{"minimum": 66.93, "maximum": 84.29, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 84.29, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 66.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE FOR TRANSFUSION", "code_information": [{"code": "76941", "type": "CPT"}], "standard_charges": [{"minimum": 111.59, "maximum": 112.96, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 111.59, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 112.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE OVA ASPIRATION", "code_information": [{"code": "76948", "type": "CPT"}], "standard_charges": [{"minimum": 38.0, "maximum": 38.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 38.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO GUIDE VILLUS SAMPLING", "code_information": [{"code": "76945", "type": "CPT"}], "standard_charges": [{"minimum": 83.35, "maximum": 83.35, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 83.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93312", "type": "CPT"}], "standard_charges": [{"minimum": 155.74, "maximum": 723.74, "discounted_cash": 954.21, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 155.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 705.13, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 723.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93313", "type": "CPT"}], "standard_charges": [{"minimum": 705.13, "maximum": 723.74, "discounted_cash": 954.21, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 705.13, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 723.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93315", "type": "CPT"}], "standard_charges": [{"minimum": 193.23, "maximum": 723.74, "discounted_cash": 954.21, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 193.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 705.13, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 723.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL", "code_information": [{"code": "93316", "type": "CPT"}], "standard_charges": [{"minimum": 705.13, "maximum": 723.74, "discounted_cash": 954.21, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 705.13, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 723.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL (TEE)", "code_information": [{"code": "93355", "type": "CPT"}], "standard_charges": [{"minimum": 193.26, "maximum": 193.26, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 193.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSESOPHAGEAL INTRAOP", "code_information": [{"code": "93318", "type": "CPT"}], "standard_charges": [{"minimum": 256.0, "maximum": 723.74, "discounted_cash": 954.21, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 256.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 705.13, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 723.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "ECHO TRANSTHORACIC", "code_information": [{"code": "93303", "type": "CPT"}], "standard_charges": [{"minimum": 152.65, "maximum": 723.74, 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"methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTOTRIPSY MAL HEPATCEL TIS", "code_information": [{"code": "686T", "type": "CPT"}], "standard_charges": [{"minimum": 2807.0, "maximum": 24096.57, "discounted_cash": 29913.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4534.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 23476.94, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 24096.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HISTRELIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1675", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.05, "maximum": 1.05, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 1.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ALPHA-1-PROTEINAS DIEM", "code_information": [{"code": "S9346", "type": "HCPCS"}], "standard_charges": [{"minimum": 57.76, "maximum": 57.76, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 57.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-HEMOPHIL DIEM", "code_information": [{"code": "S9345", "type": "HCPCS"}], "standard_charges": [{"minimum": 118.68, "maximum": 118.68, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 118.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-SPASMOTIC DIEM", "code_information": [{"code": "S9363", "type": "HCPCS"}], "standard_charges": [{"minimum": 68.26, "maximum": 68.26, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 68.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ANTI-TNF PER DIEM", "code_information": [{"code": "S9359", "type": "HCPCS"}], "standard_charges": [{"minimum": 113.14, "maximum": 113.14, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 113.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q12H DIEM", "code_information": [{"code": "S9501", "type": "HCPCS"}], "standard_charges": [{"minimum": 95.04, "maximum": 95.04, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 95.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q24H DIEM", "code_information": [{"code": "S9500", "type": "HCPCS"}], "standard_charges": [{"minimum": 95.04, "maximum": 95.04, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 95.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q3H DIEM", "code_information": [{"code": "S9497", "type": "HCPCS"}], "standard_charges": [{"minimum": 172.04, "maximum": 172.04, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 172.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ANTIBIOTIC Q4H DIEM", "code_information": [{"code": "S9504", "type": "HCPCS"}], "standard_charges": [{"minimum": 172.04, "maximum": 172.04, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", 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"outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 94.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT BLOOD PRODUCTS DIEM", "code_information": [{"code": "S9538", "type": "HCPCS"}], "standard_charges": [{"minimum": 103.97, "maximum": 103.97, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 103.97, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CATH CARE NOC", "code_information": [{"code": "S5497", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.9, "maximum": 18.9, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 18.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CATH REPAIR KIT", "code_information": [{"code": "S5518", "type": "HCPCS"}], "standard_charges": [{"minimum": 304.57, "maximum": 304.57, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 304.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CHELATION DIEM", "code_information": [{"code": "S9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 91.64, "maximum": 91.64, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 91.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CHEMO PER DIEM", "code_information": [{"code": "S9329", "type": "HCPCS"}], "standard_charges": [{"minimum": 109.84, "maximum": 109.84, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 109.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT COMPLEX CATH CARE", "code_information": [{"code": "S5501", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.61, "maximum": 17.61, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 17.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CONT ANTICOAG DIEM", "code_information": [{"code": "S9336", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.88, "maximum": 67.88, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 67.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CONT ANTIEMETIC DIEM", "code_information": [{"code": "S9351", "type": "HCPCS"}], "standard_charges": [{"minimum": 147.08, "maximum": 147.08, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 147.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CONT CHEM DIEM", "code_information": [{"code": "S9330", "type": "HCPCS"}], "standard_charges": [{"minimum": 125.59, "maximum": 125.59, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 125.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CONT INSULIN DIEM", "code_information": [{"code": "S9353", "type": "HCPCS"}], "standard_charges": [{"minimum": 178.54, "maximum": 178.54, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 178.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CONT PAIN PER DIEM", "code_information": [{"code": "S9326", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.66, "maximum": 73.66, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 73.66, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT CORTICOSTEROID/DIEM", "code_information": [{"code": "S9490", "type": "HCPCS"}], "standard_charges": [{"minimum": 124.04, "maximum": 124.04, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 124.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT DECLOTTING KIT", "code_information": [{"code": "S5517", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.91, "maximum": 50.91, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 50.91, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT DIURETIC INFUS DIEM", "code_information": [{"code": "S9361", "type": "HCPCS"}], "standard_charges": [{"minimum": 61.96, "maximum": 61.96, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 61.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL BOLUS NURS", "code_information": [{"code": "S9343", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.84, "maximum": 15.84, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 15.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL GRAV DIEM", "code_information": [{"code": "S9341", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.37, "maximum": 20.37, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 20.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL PER DIEM", "code_information": [{"code": "S9340", "type": "HCPCS"}], "standard_charges": [{"minimum": 39.18, "maximum": 39.18, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 39.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ENTERAL PUMP DIEM", "code_information": [{"code": "S9342", "type": "HCPCS"}], "standard_charges": [{"minimum": 28.29, "maximum": 28.29, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 28.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT ENZYME REPLACE DIEM", "code_information": [{"code": "S9357", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.86, "maximum": 84.86, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 84.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 1 LITER DIEM", "code_information": [{"code": "S9374", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.22, "maximum": 88.22, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 88.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 2 LITER DIEM", "code_information": [{"code": "S9375", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.22, "maximum": 88.22, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 88.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA 3 LITER DIEM", "code_information": [{"code": "S9376", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.22, "maximum": 88.22, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 88.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA OVER 3L DIEM", "code_information": [{"code": "S9377", "type": "HCPCS"}], "standard_charges": [{"minimum": 88.22, "maximum": 88.22, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 88.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT HYDRA TOTAL DIEM", "code_information": [{"code": "S9373", "type": "HCPCS"}], "standard_charges": [{"minimum": 71.23, "maximum": 71.23, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 71.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT IMMUNOTHERAPY DIEM", "code_information": [{"code": "S9338", "type": "HCPCS"}], "standard_charges": [{"minimum": 99.77, "maximum": 99.77, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 99.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT INJ INTERFERON DIEM", "code_information": [{"code": "S9559", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.8, "maximum": 16.8, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 16.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT INT PAIN PER DIEM", "code_information": [{"code": "S9327", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.02, "maximum": 84.02, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 84.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT INTERIM CATH CARE", "code_information": [{"code": "S5502", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.21, "maximum": 25.21, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 25.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT INTERMIT CHEMO DIEM", "code_information": [{"code": "S9331", "type": "HCPCS"}], "standard_charges": [{"minimum": 84.86, "maximum": 84.86, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 84.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT LONGTERM INFUSION DIEM", "code_information": [{"code": "S9347", "type": "HCPCS"}], "standard_charges": [{"minimum": 67.88, "maximum": 67.88, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 67.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT MIDLINE CATH INSERT KIT", "code_information": [{"code": "S5521", "type": "HCPCS"}], "standard_charges": [{"minimum": 110.88, "maximum": 110.88, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 110.88, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT PAIN IMP PUMP DIEM", "code_information": [{"code": "S9328", "type": "HCPCS"}], "standard_charges": [{"minimum": 73.52, "maximum": 73.52, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 73.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT PAIN MGMT PER DIEM", "code_information": [{"code": "S9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 79.2, "maximum": 79.2, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 79.2, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT PERITON DIALYSIS DIEM", "code_information": [{"code": "S9339", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.37, "maximum": 199.54, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 60.37, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 199.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT PICC INSERT KIT", "code_information": [{"code": "S5520", "type": "HCPCS"}], "standard_charges": [{"minimum": 152.74, "maximum": 152.74, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 152.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT PICC INSERT NO SUPP", "code_information": [{"code": "S5522", "type": "HCPCS"}], "standard_charges": [{"minimum": 231.05, "maximum": 231.05, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 231.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT SIMPLE CATH CARE", "code_information": [{"code": "S5498", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.24, "maximum": 14.24, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 14.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT SYMPATHOMIM DIEM", "code_information": [{"code": "S9348", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.77, "maximum": 78.77, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 78.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HIT TOCOLYSIS DIEM", "code_information": [{"code": "S9349", "type": "HCPCS"}], "standard_charges": 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198.67, "maximum": 198.67, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 198.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT SING/M/FAM COUNS", "code_information": [{"code": "99510", "type": "CPT"}], "standard_charges": [{"minimum": 33.76, "maximum": 173.29, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 33.76, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 173.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "HOME VISIT STOMA CARE", "code_information": [{"code": "99505", "type": "CPT"}], "standard_charges": [{"minimum": 143.04, "maximum": 143.04, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 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"plan_name": "Medicare", "standard_charge_dollar": 255.89, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 190.75, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INITIAT MED ASSIST TX IN ER", "code_information": [{"code": "G2213", "type": "HCPCS"}], "standard_charges": [{"minimum": 58.3, "maximum": 58.3, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 58.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ACETAMINOPHEN -FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0134", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.06, "maximum": 4.51, "setting": "outpatient", "payers_information": [{"payer_name": 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APOTEX/BENDAMUSTINE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9058", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.24, "maximum": 28.61, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 25.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 27.88, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 28.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ARIPIPRAZOLE EXT REL 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0401", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.14, "maximum": 11.27, "discounted_cash": 12.44, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 11.27, 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"Humana", "plan_name": "Medicare", "standard_charge_dollar": 72.03, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 73.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BETA INTERFERON SQ 1 MCG", "code_information": [{"code": "Q3028", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.21, "maximum": 353.55, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 11.21, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 353.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BIMATOPROST ITC IMP1MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7351", "type": "HCPCS"}], "standard_charges": [{"minimum": 206.21, "maximum": 283.92, "discounted_cash": 365.5, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 206.21, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 276.62, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 283.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BIPERIDEN LACTATE/5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0190", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.35, "maximum": 31.35, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 31.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ BUPRENORPH (BRIXADI) 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0576", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.22, "maximum": 17.67, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 17.22, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 17.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CALCITRIOL PER 0.1 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0636", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.21, "maximum": 5.21, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, BAXTER", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0689", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.65, "maximum": 5.69, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.69, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.65, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CEFAZOLIN SODIUM, HIKMA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0688", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.5, "maximum": 5.5, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CEFTOLOZANE TAZOBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0695", "type": "HCPCS"}], "standard_charges": [{"minimum": 9.88, "maximum": 14.88, "discounted_cash": 15.51, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 9.88, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 10.14, "methodology": "fee schedule"}], "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": 20.23, "maximum": 23.04, "discounted_cash": 18.25, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 23.04, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 20.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 21.71, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CODEINE PHOSPHATE /30 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0745", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.61, "maximum": 6.61, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 6.61, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CRIZANLIZUMAB-TMCA 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0791", "type": "HCPCS"}], "standard_charges": [{"minimum": 131.56, "maximum": 175.0, "discounted_cash": 221.32, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 131.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 170.5, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 175.0, "methodology": "fee schedule"}], "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": 916.54, "maximum": 1255.84, "discounted_cash": 1786.43, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 916.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1223.55, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1255.84, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CUTAQUIG 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1551", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.35, "maximum": 19.12, "discounted_cash": 24.33, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 18.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 18.63, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 19.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CUVITRU, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1555", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.38, "maximum": 21.92, "discounted_cash": 28.78, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 20.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 21.36, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 21.92, "methodology": "fee schedule"}], "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": 5.04, "maximum": 8.11, "discounted_cash": 15.58, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 5.04, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 5.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ CYCLOPHOSPHAMD AUROMEDIC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9071", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.4, "maximum": 6.25, "discounted_cash": 1.07, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.25, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2.4, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DAUNORUBICIN, CYTARABINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9153", "type": "HCPCS"}], "standard_charges": [{"minimum": 219.06, "maximum": 319.12, "discounted_cash": 437.73, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 219.06, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 236.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 310.91, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 319.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DAXIBOTULINUMTOXINA-LANM", "code_information": [{"code": "C9160", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.97, "maximum": 6.13, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 5.97, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 6.13, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DELANDISTROGENE MOX ROKL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1413", "type": "HCPCS"}], "standard_charges": [{"minimum": 4421586.7, "maximum": 4538285.47, "discounted_cash": 5668716.74, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4421586.7, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4538285.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DESMOPRESSIN ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2597", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.49, "maximum": 8.72, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 8.49, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 8.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DEXAMETHASONE ACETATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1094", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.99, "maximum": 2.85, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 1.99, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2.85, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DICLOFENAC SODIUM 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1130", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.67, "maximum": 43.33, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.67, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 43.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DIHYDROERGOTAMINE MESYLT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1110", "type": "HCPCS"}], "standard_charges": [{"minimum": 46.8, "maximum": 46.8, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 46.8, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DOBUTAMINE HCL/250 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1250", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.31, "maximum": 14.31, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 14.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ DUPUYTREN CORD W/ENZYME", "code_information": [{"code": "20527", "type": "CPT"}], "standard_charges": [{"minimum": 49.32, "maximum": 2807.0, "discounted_cash": 536.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 986.66, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 49.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 378.57, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 388.56, "methodology": "fee schedule"}], "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": 35.76, "maximum": 44.38, "discounted_cash": 57.92, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 35.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 43.24, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 44.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ EFGARTIGIMOD 2MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9332", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.54, "maximum": 44.17, "discounted_cash": 54.96, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 36.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 43.04, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 44.17, "methodology": "fee schedule"}], "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": 34.14, "maximum": 40.87, "discounted_cash": 35.68, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 34.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 39.82, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 40.87, "methodology": "fee schedule"}], "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": 32.57, "maximum": 48.23, "discounted_cash": 62.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 32.57, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 39.49, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 46.99, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 48.23, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ENOXAPARIN SODIUM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1650", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.14, "maximum": 5.14, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}], "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": 58.26, "maximum": 74.08, "discounted_cash": 95.45, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 58.26, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 72.17, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 74.08, "methodology": "fee schedule"}], "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": 0.6, "maximum": 4.91, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.6, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 0.62, "methodology": "fee schedule"}], "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": 376.61, "maximum": 512.41, "discounted_cash": 670.14, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 376.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 499.23, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 512.41, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FE-BASED MR CONTRAST,1ML", "code_information": [{"code": "Q9953", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.33, "maximum": 94.28, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 24.33, "methodology": "fee schedule"}, {"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 44.64, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 94.28, "methodology": "fee schedule"}], "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": 136.28, "maximum": 181.51, "discounted_cash": 241.0, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 136.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 176.85, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 181.51, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FERRIC CARBOXYMALTOS 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1439", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.53, "maximum": 5.61, "discounted_cash": 1.89, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.53, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.58, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FILGRASTIM EXCL BIOSIMIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1442", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.32, "maximum": 5.45, "discounted_cash": 1.71, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.32, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.35, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FLUPHENAZINE HCL 1.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2679", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.01, "maximum": 12.01, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 12.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN ALFA 75 IU", "code_information": [{"code": "S0126", "type": "HCPCS"}], "standard_charges": [{"minimum": 686.08, "maximum": 1849.81, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 1849.81, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 686.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOLLITROPIN BETA 75 IU", "code_information": [{"code": "S0128", "type": "HCPCS"}], "standard_charges": [{"minimum": 1536.15, "maximum": 1855.44, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 1855.44, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 1536.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ FOR SACROILIAC JT ANESTH", "code_information": [{"code": "G0260", "type": "HCPCS"}], "standard_charges": [{"minimum": 362.67, "maximum": 2807.0, "discounted_cash": 1232.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 986.66, "methodology": "case 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"discounted_cash": 983.67, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 178.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 931.24, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 955.82, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GANIRELIX ACETAT 250 MCG", "code_information": [{"code": "S0132", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.92, "maximum": 273.79, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 201.45, "methodology": "fee schedule"}, {"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 128.92, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 273.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GEMCITABINE HCL (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9196", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.77, "maximum": 13.24, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 13.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 11.77, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 12.09, "methodology": "fee schedule"}], "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": 116.54, "maximum": 154.33, "discounted_cash": 200.6, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 116.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 150.36, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 154.33, "methodology": "fee schedule"}], "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": 2712.39, "maximum": 3728.56, "discounted_cash": 4731.05, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 2712.39, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3632.68, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3728.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ GLUCAGON HCL, FRESENIUS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1611", "type": "HCPCS"}], "standard_charges": [{"minimum": 128.29, "maximum": 170.5, "discounted_cash": 254.67, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 128.29, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 166.11, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 170.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN SODIUM PER 10 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1642", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.48, "maximum": 4.48, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN SODIUM PER 1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1644", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.73, "maximum": 4.73, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HEPARIN, PFIZER, 1000U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1643", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.15, "maximum": 9.04, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 9.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 6.15, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 6.31, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HERZUMA 10 MG", "code_information": [{"code": "Q5113", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.4, "maximum": 55.5, "discounted_cash": 118.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 36.4, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 44.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 54.08, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 55.5, "methodology": "fee schedule"}], "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": 1.85, "maximum": 22.02, "discounted_cash": 2.6, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.84, "methodology": "fee schedule"}, {"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 22.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.85, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.9, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ HYDROXYPROGST CAPOAT NOS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1729", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.1, "maximum": 25.03, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 18.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 24.39, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 25.03, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 18.81, "methodology": "fee schedule"}], "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": 3.3, "maximum": 6.92, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3.3, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3.39, "methodology": "fee schedule"}], "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": 2477.62, "maximum": 3552.62, "discounted_cash": 4611.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2477.62, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 2584.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3461.27, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3552.62, "methodology": "fee schedule"}], "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": 60.06, "maximum": 85.4, "discounted_cash": 112.81, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 60.06, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 66.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 83.2, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 85.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ IRON DEXTRAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1750", "type": "HCPCS"}], "standard_charges": [{"minimum": 21.78, "maximum": 23.86, "discounted_cash": 30.96, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 21.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 23.24, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 23.86, "methodology": "fee schedule"}], "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": 52.75, "maximum": 66.49, "discounted_cash": 86.74, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 52.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 64.78, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 66.49, "methodology": "fee schedule"}], "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": 3.43, "maximum": 7.02, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 7.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3.43, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ LEFAMULIN 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0691", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.97, "maximum": 5.14, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.14, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.97, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "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": 0.09, "maximum": 4.53, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 0.13, "methodology": "fee schedule"}], "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": 205.09, "maximum": 276.24, "discounted_cash": 370.75, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 205.09, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 269.14, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 276.24, "methodology": "fee schedule"}], "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": 44.43, "maximum": 55.04, "discounted_cash": 71.76, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 44.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 53.63, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 55.04, "methodology": "fee schedule"}], "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": 2837.79, "maximum": 3954.86, "discounted_cash": 5132.21, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 2837.79, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3853.16, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3954.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MAGNESIUM SULFATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3475", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.15, "maximum": 5.15, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.15, "methodology": "fee schedule"}], "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": 152.48, "maximum": 220.66, "discounted_cash": 163.92, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 220.66, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 152.48, 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"setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 7.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ METARAMINOL BITARTRATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0380", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.01, "maximum": 0.01, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 0.01, "methodology": "fee schedule"}], "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": 0.38, "maximum": 4.74, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.38, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 0.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MIDAZOLAM HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2250", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.6, "maximum": 4.6, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.6, "methodology": "fee schedule"}], "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": 217.57, "maximum": 322.42, "discounted_cash": 424.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", 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"HCPCS"}], "standard_charges": [{"minimum": 634.1, "maximum": 866.95, "discounted_cash": 1118.94, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 634.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 844.66, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 866.95, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ MOXIFLOXACIN (FRES KABI)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2281", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.79, "maximum": 10.27, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 10.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 7.79, "methodology": 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{"description": "INJ NALOXONE HYDROCHLORIDE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2310", "type": "HCPCS"}], "standard_charges": [{"minimum": 11.75, "maximum": 11.75, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 11.75, "methodology": "fee schedule"}], "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": 191.61, "maximum": 257.69, "discounted_cash": 338.14, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 191.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 251.06, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", 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"HCPCS"}], "standard_charges": [{"minimum": 104498.96, "maximum": 3170720.33, "discounted_cash": 4196437.1, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3089187.52, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3170720.33, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 104498.96, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ ONTRUZANT 10 MG", "code_information": [{"code": "Q5112", "type": "HCPCS"}], "standard_charges": [{"minimum": 43.4, "maximum": 58.34, "discounted_cash": 32.48, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 58.34, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 43.4, "methodology": "fee 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"standard_charge_dollar": 69.78, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEGFILGRASTIM-BMEZ 0.5MG", "code_information": [{"code": "Q5120", "type": "HCPCS"}], "standard_charges": [{"minimum": 331.59, "maximum": 477.45, "discounted_cash": 51.82, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 331.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 465.17, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 477.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMBROLIZUMAB", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9271", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.91, "maximum": 76.73, "discounted_cash": 103.06, "setting": "outpatient", "payers_information": 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"fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 13.29, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (BLUEPOINT)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9322", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.07, "maximum": 14.07, "discounted_cash": 18.12, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 14.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (SANDOZ) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9297", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.74, "maximum": 5.76, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.76, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.74, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED (TEVA) 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9314", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.95, "maximum": 27.48, "discounted_cash": 26.56, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 23.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 26.77, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 27.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED DITROMETHAMIN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9323", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.06, "maximum": 10.47, "discounted_cash": 0.22, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 10.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 8.27, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PEMETREXED, HOSPIRA 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9294", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.16, "maximum": 15.01, "discounted_cash": 6.06, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 15.01, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 14.16, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 14.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PERFLEXANE LIP MICROS,ML", "code_information": [{"code": "Q9955", "type": "HCPCS"}], "standard_charges": [{"minimum": 155.11, "maximum": 155.11, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 155.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PERFLUTREN LIP MICROS,ML", "code_information": [{"code": "Q9957", "type": "HCPCS"}], "standard_charges": [{"minimum": 50.24, "maximum": 50.24, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 50.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PHENYLEPHRINE HCL 20 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2371", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.47, "maximum": 4.47, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PLASMINOGEN TVMH 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2998", "type": "HCPCS"}], "standard_charges": [{"minimum": 34.46, "maximum": 43.79, "discounted_cash": 56.01, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 34.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 42.66, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 43.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PROGESTERONE PER 50 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2675", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.37, "maximum": 5.37, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PROHANCE MULTIPACK", "code_information": [{"code": "A9576", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.42, "maximum": 1.42, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PROTAMINE SULFATE/10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2720", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.12, "maximum": 6.12, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ PROTIRELIN PER 250 MCG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2725", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.74, "maximum": 140.83, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 140.83, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 31.74, "methodology": "fee schedule"}], "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": 2.78, "maximum": 2.86, "discounted_cash": 3.79, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2.78, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT ESRD ON DIALYSI", "code_information": [{"code": "Q5105", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.05, "maximum": 5.24, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.05, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RETACRIT NON-ESRD USE", "code_information": [{"code": "Q5106", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.5, "maximum": 12.28, "discounted_cash": 13.42, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 12.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 10.5, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 10.77, "methodology": "fee schedule"}], "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": 19.82, "maximum": 21.16, "discounted_cash": 25.53, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 19.82, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 20.61, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 21.16, "methodology": "fee schedule"}], "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": 16.3, "maximum": 16.73, "discounted_cash": 18.77, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 16.61, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 16.3, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 16.73, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RITUXIMAB, HYALURONIDASE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9311", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.17, "maximum": 51.5, "discounted_cash": 62.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 37.17, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 41.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 50.18, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 51.5, "methodology": "fee schedule"}], "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": 11332.59, "maximum": 16533.65, "discounted_cash": 21457.63, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 11332.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 16108.5, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 16533.65, "methodology": "fee schedule"}], "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": 32.16, "maximum": 44.01, "discounted_cash": 52.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 32.16, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 36.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 42.87, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 44.01, "methodology": "fee schedule"}], "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": 31.86, "maximum": 46.68, "discounted_cash": 48.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 31.86, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 36.45, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 45.48, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 46.68, "methodology": "fee schedule"}], "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": 26.07, "maximum": 30.64, "discounted_cash": 39.6, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 26.07, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 29.85, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 30.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ RUXIENCE, 10 MG", "code_information": [{"code": "Q5119", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.91, "maximum": 32.68, "discounted_cash": 47.61, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 32.68, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 24.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 27.43, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 28.15, "methodology": "fee schedule"}], "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": 514.96, "maximum": 741.8, "discounted_cash": 922.85, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 514.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 722.73, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 741.8, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 565.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SECRETIN SYNTHETIC HUMAN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2850", "type": "HCPCS"}], "standard_charges": [{"minimum": 37.27, "maximum": 57.47, "discounted_cash": 69.25, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 37.27, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 55.99, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 57.47, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 38.46, "methodology": "fee schedule"}], "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": 113.75, "maximum": 150.48, "discounted_cash": 144.55, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 113.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 146.61, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 150.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ SODIUM THIOSULFATE 100MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0208", "type": "HCPCS"}], "standard_charges": [{"minimum": 95.8, "maximum": 132.45, "discounted_cash": 162.56, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 95.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 129.04, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 132.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TALIMOGENE LAHERPAREPVEC", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9325", "type": "HCPCS"}], "standard_charges": [{"minimum": 62.68, "maximum": 91.69, "discounted_cash": 126.39, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 62.68, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 71.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 89.33, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 91.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TALQUETAMAB-TGVS 0.25 MG", "code_information": [{"code": "C9163", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.47, "maximum": 91.83, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 89.47, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 91.83, "methodology": "fee schedule"}], "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": 0.41, "maximum": 4.9, "discounted_cash": 0.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 0.41, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.9, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.59, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 0.61, "methodology": "fee schedule"}], "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": 35.31, "maximum": 42.47, "discounted_cash": 57.39, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 35.31, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 41.38, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 42.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TEDIZOLID PHOSPHATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3090", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.39, "maximum": 6.24, "discounted_cash": 3.36, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.24, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2.39, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TENDON ORIGIN/INSERTION", "code_information": [{"code": "20551", "type": "CPT"}], "standard_charges": [{"minimum": 52.58, "maximum": 2807.0, "discounted_cash": 536.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 986.66, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 52.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 378.57, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 388.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TENDON SHEATH/LIGAMENT", "code_information": [{"code": "20550", "type": "CPT"}], "standard_charges": [{"minimum": 52.58, "maximum": 2807.0, "discounted_cash": 536.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 986.66, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 52.58, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 378.57, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 388.56, "methodology": "fee schedule"}], "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": 40.72, "maximum": 49.92, "discounted_cash": 64.37, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 40.72, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 48.63, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 49.92, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TESTOSTERONE CYPIONATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1071", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.49, "maximum": 4.49, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TEZEPELUMAB-EKKO, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2356", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.05, "maximum": 25.59, "discounted_cash": 30.78, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 23.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 24.93, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 25.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ THEOPHYLLINE PER 40 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2810", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.05, "maximum": 1.05, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 1.05, "methodology": "fee schedule"}], "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": 172.77, "maximum": 231.75, "discounted_cash": 322.63, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 172.77, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 225.79, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 231.75, "methodology": "fee schedule"}], "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": 155.3, "maximum": 207.69, "discounted_cash": 272.46, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 155.3, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 202.35, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 207.69, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRASTUZUMAB EXCL BIOSIMI", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9355", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.74, "maximum": 110.8, "discounted_cash": 128.24, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 82.74, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 84.93, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 107.95, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 110.8, "methodology": "fee schedule"}], "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": 22.0, "maximum": 24.15, "discounted_cash": 31.28, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 22.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 23.53, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 24.15, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIFERIC AVNU 0.1MG IRON", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1445", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.64, "maximum": 4.64, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIGGER POINT 1/2 MUSCL", "code_information": [{"code": "20552", "type": "CPT"}], "standard_charges": [{"minimum": 52.49, "maximum": 2807.0, "discounted_cash": 536.03, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 986.66, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 52.49, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 378.57, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 282.2, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 388.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRIMETREXATE GLUCORONATE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3305", "type": "HCPCS"}], "standard_charges": [{"minimum": 247.67, "maximum": 759.72, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 247.67, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 759.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ TRUXIMA 10 MG", "code_information": [{"code": "Q5115", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.35, "maximum": 49.42, "discounted_cash": 50.22, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 48.83, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 40.35, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 48.15, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 49.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ UBLITUXIMAB-XIIY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2329", "type": "HCPCS"}], "standard_charges": [{"minimum": 72.12, "maximum": 93.17, "discounted_cash": 120.93, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 72.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 90.77, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 93.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ VASOPRESSIN (AM REG) 1 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2599", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.62, "maximum": 4.92, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.62, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 0.64, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ VELMANASE ALFA-TYCV 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0217", "type": "HCPCS"}], "standard_charges": [{"minimum": 404.46, "maximum": 583.81, "discounted_cash": 795.21, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 404.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 568.8, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 583.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ W/FLUOR EVAL CV DEVICE", "code_information": [{"code": "36598", "type": "CPT"}], "standard_charges": [{"minimum": 110.57, "maximum": 3035.0, "discounted_cash": 371.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3035.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 986.66, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 110.57, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 273.96, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 204.22, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 281.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ XIPERE 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3299", "type": "HCPCS"}], "standard_charges": [{"minimum": 53.04, "maximum": 66.9, "discounted_cash": 82.0, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 53.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 65.18, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 66.9, "methodology": "fee schedule"}], "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": 7.9, "maximum": 10.34, "discounted_cash": 10.31, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 10.34, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 7.9, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 8.11, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ABRILADA, 10 MG", "code_information": [{"code": "Q5132", "type": "HCPCS"}], "standard_charges": [{"minimum": 1032.04, "maximum": 1032.04, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 1032.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (B BRAUN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0136", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 4.52, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (HIKMA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0137", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.07, "maximum": 4.51, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 0.07, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ACETAMINOPHEN (NOS)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0131", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.42, "maximum": 4.51, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.51, "methodology": "fee schedule"}, {"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 1.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ADO-TRASTUZUMAB EMT 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9354", "type": "HCPCS"}], "standard_charges": [{"minimum": 36.27, "maximum": 52.83, "discounted_cash": 72.07, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 36.27, "methodology": "fee 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"billing_class": "facility"}]}, {"description": "INJ, AFLIBERCEPT HD, 1 MG", "code_information": [{"code": "C9161", "type": "HCPCS"}], "standard_charges": [{"minimum": 453.38, "maximum": 465.35, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 453.38, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 465.35, "methodology": "fee schedule"}], "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": 1.93, "maximum": 1.98, "discounted_cash": 2.69, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.93, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.98, "methodology": 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"plan_name": "Medi-Cal", "standard_charge_dollar": 55.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 68.36, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 70.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ATEZOLIZUMAB,10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9022", "type": "HCPCS"}], "standard_charges": [{"minimum": 80.8, "maximum": 117.05, "discounted_cash": 156.13, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 80.8, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 89.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 114.04, "methodology": "fee schedule"}, {"payer_name": 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"plan_name": "Medicare", "standard_charge_dollar": 2.35, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, CLINDAMYCIN PHOSP 300MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0736", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.56, "maximum": 6.36, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.36, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2.56, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0874", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.54, "maximum": 4.54, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.54, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (HOSPIRA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0877", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.09, "maximum": 4.53, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 0.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, DAPTOMYCIN (XELLIA)", "drug_information": {"unit": 1.0, "type": 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{"description": "INJ, ETEPLIRSEN, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1428", "type": "HCPCS"}], "standard_charges": [{"minimum": 164.46, "maximum": 175.56, "discounted_cash": 286.05, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 164.46, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 175.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, EVINACUMAB-DGNB, 5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1305", "type": "HCPCS"}], "standard_charges": [{"minimum": 183.6, "maximum": 246.66, "discounted_cash": 331.18, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 183.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 240.31, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 246.66, "methodology": "fee schedule"}], "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": 12.22, "maximum": 12.55, "discounted_cash": 16.72, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 12.22, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 12.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, FARICIMAB-SVOA, 0.1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2777", "type": "HCPCS"}], "standard_charges": [{"minimum": 40.55, "maximum": 49.7, 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{"description": "INJ, INVEGA HAFYERA/TRINZA", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2427", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.38, "maximum": 16.81, "discounted_cash": 22.22, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 16.67, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 16.38, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, INVEGA SUSTENNA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2426", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.78, "maximum": 19.72, "discounted_cash": 25.82, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", 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"standard_charge_dollar": 108.37, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 111.23, "methodology": "fee schedule"}], "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": 22.23, "maximum": 24.47, "discounted_cash": 32.23, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 22.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 23.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 24.47, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TALIGLUCERASE ALFA 10 U", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": 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"Medicare", "standard_charge_dollar": 280.27, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 287.67, "methodology": "fee schedule"}], "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": 140.55, "maximum": 187.38, "discounted_cash": 240.83, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 140.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 182.56, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 187.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, TRIVISC 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7329", "type": "HCPCS"}], "standard_charges": [{"minimum": 10.61, "maximum": 10.89, "discounted_cash": 8.03, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 10.61, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 10.89, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, UZEDY, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2799", "type": "HCPCS"}], "standard_charges": [{"minimum": 29.16, "maximum": 34.01, "discounted_cash": 42.8, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 29.16, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 33.13, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 34.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (MYLAN)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3371", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.01, "maximum": 10.43, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 10.43, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 8.01, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 8.22, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VANCOMYCIN HCL (XELLIA)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3372", "type": "HCPCS"}], "standard_charges": [{"minimum": 8.83, "maximum": 11.04, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 11.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 9.06, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VASOPRESSIN, 1 UNIT", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2598", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.43, "maximum": 6.28, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.28, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2.43, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VEGZELMA, 10 MG", "code_information": [{"code": "Q5129", "type": "HCPCS"}], "standard_charges": [{"minimum": 76.87, "maximum": 99.71, "discounted_cash": 68.31, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 76.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 97.14, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 99.71, "methodology": "fee schedule"}], "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": 3425.58, "maximum": 4710.1, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3425.58, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 3443.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4588.98, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4710.1, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, VUTRISIRAN, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0225", "type": "HCPCS"}], "standard_charges": [{"minimum": 4951.84, "maximum": 6812.09, "discounted_cash": 8552.56, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4951.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 6636.92, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 6812.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ, ZIV-AFLIBERCEPT, 1MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9400", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.01, "maximum": 11.74, "discounted_cash": 13.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 7.01, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 11.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 9.77, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 10.03, "methodology": "fee schedule"}], "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": 3453.54, "maximum": 4611.25, "discounted_cash": 6041.57, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 3453.54, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4492.68, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4611.25, "methodology": "fee schedule"}], "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": 4099.78, "maximum": 5638.87, "discounted_cash": 7067.17, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4099.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 5493.87, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 5638.87, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ASCENIV", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1554", "type": "HCPCS"}], "standard_charges": [{"minimum": 495.87, "maximum": 676.62, "discounted_cash": 849.06, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 495.87, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 659.22, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 676.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. AVSOLA, 10 MG", "code_information": [{"code": "Q5121", "type": "HCPCS"}], "standard_charges": [{"minimum": 30.02, "maximum": 35.19, "discounted_cash": 34.88, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 30.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 34.28, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 35.19, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BELRAPZO/BENDAMUSTINE", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9036", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.55, "maximum": 18.27, "discounted_cash": 20.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 18.27, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 17.55, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 18.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. BYOOVIZ, 0.1 MG", "code_information": [{"code": "Q5124", "type": "HCPCS"}], "standard_charges": [{"minimum": 191.97, "maximum": 258.18, "discounted_cash": 105.64, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 191.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 251.55, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 258.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CALASPARGASE PEGOL-MKNL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9118", "type": "HCPCS"}], "standard_charges": [{"minimum": 70.76, "maximum": 77.34, "discounted_cash": 140.3, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 70.76, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 77.34, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. CEFEPIME HCL (BAXTER)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0701", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.56, "maximum": 10.1, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 10.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 7.56, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 7.76, "methodology": "fee schedule"}], "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": 19.53, "maximum": 20.76, "discounted_cash": 28.23, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 20.22, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 20.76, "methodology": "fee schedule"}], "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": 22.52, "maximum": 24.86, "discounted_cash": 34.14, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 22.52, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 24.22, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 24.86, "methodology": "fee schedule"}], "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": 23.32, "maximum": 25.98, "discounted_cash": 37.64, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 23.32, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 25.31, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 25.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. HERCEPTIN HYLECTA, 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9356", "type": "HCPCS"}], "standard_charges": [{"minimum": 65.49, "maximum": 90.91, "discounted_cash": 105.02, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 65.49, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 70.48, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 88.57, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 90.91, "methodology": "fee schedule"}], "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": 477.97, "maximum": 651.99, "discounted_cash": 847.03, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 477.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 635.22, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 651.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INFUGEM, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9198", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.29, "maximum": 55.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 27.29, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 44.74, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 54.03, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 55.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (FIASP)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1812", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.12, "maximum": 6.12, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.12, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. INSULIN (LYUMJEV)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1814", "type": "HCPCS"}], "standard_charges": [{"minimum": 6.08, "maximum": 6.08, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.08, "methodology": "fee schedule"}], "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": 71.95, "maximum": 105.33, "discounted_cash": 139.99, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 71.95, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 80.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 102.62, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 105.33, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. JIVI 1 IU", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7208", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.14, "maximum": 3.22, "discounted_cash": 4.52, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3.14, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3.22, "methodology": "fee schedule"}], "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": 324.02, "maximum": 440.0, "discounted_cash": 562.43, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 324.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 428.69, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 440.0, "methodology": "fee schedule"}], "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": 185.98, "maximum": 275.39, "discounted_cash": 354.04, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 185.98, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 204.47, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 268.31, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 275.39, "methodology": "fee schedule"}], "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": 44.99, "maximum": 64.79, "discounted_cash": 89.71, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 44.99, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 51.51, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 63.12, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 64.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. MELOXICAM 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1738", "type": "HCPCS"}], "standard_charges": [{"minimum": 7.59, "maximum": 7.59, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 7.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. MYCOPHENOLATE MOFETIL", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7519", "type": "HCPCS"}], "standard_charges": [{"minimum": 0.97, "maximum": 5.19, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 0.97, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.0, "methodology": "fee schedule"}], "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": 546.28, "maximum": 839.59, "discounted_cash": 1172.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 546.28, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 614.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 818.0, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 839.59, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. OLANZAPINE, 0.5MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2359", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.27, "maximum": 5.41, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.41, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.27, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.3, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED NOS 10MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9305", "type": "HCPCS"}], "standard_charges": [{"minimum": 5.86, "maximum": 27.68, "discounted_cash": 7.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 27.68, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 8.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 5.86, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 6.02, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. PEMETREXED, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9304", "type": "HCPCS"}], "standard_charges": [{"minimum": 66.78, "maximum": 85.81, "discounted_cash": 79.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 81.56, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 66.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 83.6, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 85.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. RIABNI, 10 MG", "code_information": [{"code": "Q5123", "type": "HCPCS"}], "standard_charges": [{"minimum": 45.88, "maximum": 57.03, "discounted_cash": 45.32, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 49.75, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 45.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 55.56, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 57.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. ROMOSOZUMAB-AQQG 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3111", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.39, "maximum": 15.19, "discounted_cash": 20.63, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 15.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 14.39, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 14.77, "methodology": "fee schedule"}], "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": 319.99, "maximum": 448.26, "discounted_cash": 610.09, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 319.99, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 330.02, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 436.73, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 448.26, "methodology": "fee schedule"}], "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": 332.46, "maximum": 451.63, "discounted_cash": 613.94, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 332.46, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 440.01, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 451.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. TIGECYCLINE (ACCORD)", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3244", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.56, "maximum": 6.96, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3.56, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. VILTOLARSEN", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1427", "type": "HCPCS"}], "standard_charges": [{"minimum": 60.86, "maximum": 81.01, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 60.86, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 78.92, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 81.01, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ. XEMBIFY, 100 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1558", "type": "HCPCS"}], "standard_charges": [{"minimum": 18.64, "maximum": 19.53, "discounted_cash": 25.38, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 18.64, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 19.03, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 19.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., APREPITANT, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0185", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.32, "maximum": 6.19, "discounted_cash": 2.8, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.19, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2.32, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.38, "methodology": "fee schedule"}], "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": 4.14, "maximum": 7.55, "discounted_cash": 5.56, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 7.55, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4.14, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., BENDEKA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9034", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.81, "maximum": 20.32, "discounted_cash": 23.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 16.81, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 19.22, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 19.8, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 20.32, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., BENRALIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0517", "type": "HCPCS"}], "standard_charges": [{"minimum": 173.96, "maximum": 233.38, "discounted_cash": 281.32, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 173.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 227.38, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 233.38, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., BREXANOLONE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1632", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.96, "maximum": 99.28, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 78.96, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 96.72, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 99.28, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., CEMIPLIMAB-RWLC, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9119", "type": "HCPCS"}], "standard_charges": [{"minimum": 27.23, "maximum": 37.81, "discounted_cash": 50.06, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 27.23, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 31.92, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 36.84, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 37.81, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., CERLIPONASE ALFA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0567", "type": "HCPCS"}], "standard_charges": [{"minimum": 111.06, "maximum": 15093.98, "discounted_cash": 205.72, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 111.06, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 15093.98, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., COPANLISIB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9057", "type": "HCPCS"}], "standard_charges": [{"minimum": 82.18, "maximum": 120.56, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 82.18, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 117.46, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 120.56, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 95.6, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., COSYNTROPIN, 0.25 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0834", "type": "HCPCS"}], "standard_charges": [{"minimum": 31.57, "maximum": 31.57, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 31.57, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., DURVALUMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9173", "type": "HCPCS"}], "standard_charges": [{"minimum": 78.9, "maximum": 111.12, "discounted_cash": 145.49, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 78.9, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 85.17, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 108.26, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 111.12, "methodology": "fee schedule"}], "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": 380.12, "maximum": 517.24, "discounted_cash": 657.81, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 380.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 503.94, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 517.24, "methodology": "fee schedule"}], "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": 55.11, "maximum": 69.74, "discounted_cash": 95.89, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 55.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 67.95, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 69.74, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ERAVACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0122", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.51, "maximum": 5.59, "discounted_cash": 2.22, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.55, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., EVOMELA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9246", "type": "HCPCS"}], "standard_charges": [{"minimum": 16.04, "maximum": 22.7, "discounted_cash": 31.63, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 16.04, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 20.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 22.12, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 22.7, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., FIBRYGA, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7177", "type": "HCPCS"}], "standard_charges": [{"minimum": 1.47, "maximum": 5.56, "discounted_cash": 2.11, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.56, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 1.47, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 1.51, "methodology": "fee schedule"}], "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": 2.25, "maximum": 7.6, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 7.6, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2.47, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.53, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2.25, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., GUSELKUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1628", "type": "HCPCS"}], "standard_charges": [{"minimum": 97.26, "maximum": 12618.44, "discounted_cash": 129.86, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 134.78, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 97.26, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 99.82, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 12618.44, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., HAEGARDA 10 UNITS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0599", "type": "HCPCS"}], "standard_charges": [{"minimum": 3.14, "maximum": 15.46, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 15.46, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 3.14, "methodology": "fee schedule"}], "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": 79.08, "maximum": 102.75, "discounted_cash": 135.47, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 79.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 100.11, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 102.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ILUVIEN, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7313", "type": "HCPCS"}], "standard_charges": [{"minimum": 490.95, "maximum": 675.99, "discounted_cash": 851.46, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 490.95, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 658.61, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 675.99, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., KANJINTI, 10 MG", "code_information": [{"code": "Q5117", "type": "HCPCS"}], "standard_charges": [{"minimum": 17.91, "maximum": 33.37, "discounted_cash": 81.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 33.37, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 17.91, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 18.05, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 18.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., LANADELUMAB-FLYO, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0593", "type": "HCPCS"}], "standard_charges": [{"minimum": 89.74, "maximum": 124.36, "discounted_cash": 149.18, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 89.74, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 124.36, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., LUMOXITI, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9313", "type": "HCPCS"}], "standard_charges": [{"minimum": 23.39, "maximum": 32.21, "discounted_cash": 39.98, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 23.39, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 27.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 31.39, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 32.21, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., MEROPENEM, VABORBACTAM", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2186", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.08, "maximum": 6.62, "discounted_cash": 3.72, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 6.62, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2.78, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2.86, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2.08, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., OMADACYCLINE, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0121", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.91, "maximum": 8.12, "discounted_cash": 6.86, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 8.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4.91, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 5.04, "methodology": "fee schedule"}], "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": 104.44, "maximum": 137.67, "discounted_cash": 170.88, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 104.44, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 134.13, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 137.67, "methodology": "fee schedule"}], "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": 15.59, "maximum": 16.08, "discounted_cash": 20.75, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 16.08, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 15.59, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 16.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., PLAZOMICIN, 5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J0291", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.83, "maximum": 8.06, "discounted_cash": 5.97, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 8.06, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4.83, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4.96, "methodology": "fee schedule"}], "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": 226.23, "maximum": 305.36, "discounted_cash": 384.77, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 226.23, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 297.51, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 305.36, "methodology": "fee schedule"}], "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": 299.05, "maximum": 411.77, "discounted_cash": 581.68, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 299.05, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 401.18, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 411.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., RITUXIMAB, 10 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9312", "type": "HCPCS"}], "standard_charges": [{"minimum": 81.75, "maximum": 109.05, "discounted_cash": 128.57, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 81.75, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 83.66, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 106.25, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 109.05, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ROLAPITANT, 0.5 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2797", "type": "HCPCS"}], "standard_charges": [{"minimum": 2.09, "maximum": 5.35, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 5.35, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TAFASITAMAB-CXIX", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9349", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.15, "maximum": 18.72, "discounted_cash": 24.46, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 13.15, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 18.06, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 18.24, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 18.72, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TILDRAKIZUMAB, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3245", "type": "HCPCS"}], "standard_charges": [{"minimum": 145.12, "maximum": 193.67, "discounted_cash": 217.85, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 145.12, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 188.69, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 193.67, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRAZIMERA, 10 MG", "code_information": [{"code": "Q5116", "type": "HCPCS"}], "standard_charges": [{"minimum": 20.83, "maximum": 33.2, "discounted_cash": 47.84, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 33.2, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 20.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 21.95, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 22.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TREANDA 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J9033", "type": "HCPCS"}], "standard_charges": [{"minimum": 12.33, "maximum": 13.65, "discounted_cash": 3.21, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 13.65, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 12.33, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 12.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRILURON, 1 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7332", "type": "HCPCS"}], "standard_charges": [{"minimum": 13.78, "maximum": 14.73, "discounted_cash": 17.56, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 14.73, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 13.78, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 14.14, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., TRIPTORELIN XR 3.75 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3316", "type": "HCPCS"}], "standard_charges": [{"minimum": 3019.68, "maximum": 4443.77, "discounted_cash": 6524.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3019.68, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 3314.59, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4329.5, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4443.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., VESTRONIDASE ALFA-VJBK", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J3397", "type": "HCPCS"}], "standard_charges": [{"minimum": 241.4, "maximum": 260.46, "discounted_cash": 478.47, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 260.46, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 241.4, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., YUTIQ, 0.01 MG", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7314", "type": "HCPCS"}], "standard_charges": [{"minimum": 529.0, "maximum": 728.39, "discounted_cash": 905.73, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 529.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 709.66, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 728.39, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJ., ZIRABEV, 10 MG", "code_information": [{"code": "Q5118", "type": "HCPCS"}], "standard_charges": [{"minimum": 25.97, "maximum": 33.69, "discounted_cash": 44.05, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 33.69, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 25.97, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 28.86, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 29.62, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT EPIDURAL PATCH", "code_information": [{"code": "62273", "type": "CPT"}], "standard_charges": [{"minimum": 75.95, "maximum": 3194.9, "discounted_cash": 1232.68, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 3194.9, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 75.95, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 883.91, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 658.9, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 907.24, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT FOR LYMPHATIC X-RAY", "code_information": [{"code": "38790", "type": "CPT"}], "standard_charges": 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"methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SACROILIAC JOINT", "code_information": [{"code": "27096", "type": "CPT"}], "standard_charges": [{"minimum": 293.74, "maximum": 3194.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 3194.9, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 293.74, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SINUS TRACT FOR X-RAY", "code_information": [{"code": "20501", "type": "CPT"}], "standard_charges": [{"minimum": 223.38, "maximum": 2807.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 223.38, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS </W 7", "code_information": [{"code": "11900", "type": "CPT"}], "standard_charges": [{"minimum": 52.93, "maximum": 2807.0, "discounted_cash": 350.36, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 986.66, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 52.93, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 255.89, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 190.75, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 262.65, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INJECT SKIN LESIONS >7", "code_information": [{"code": "11901", "type": "CPT"}], "standard_charges": [{"minimum": 64.31, "maximum": 2807.0, 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"methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 2ND", "code_information": [{"code": "36246", "type": "CPT"}], "standard_charges": [{"minimum": 243.48, "maximum": 5611.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3035.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 5611.0, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 243.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INS CATH ABD/L-EXT ART 3RD", "code_information": [{"code": "36247", "type": "CPT"}], 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"methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4074.15, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4181.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INS CATH REN ART 1ST UNILAT", "code_information": [{"code": "36251", "type": "CPT"}], "standard_charges": [{"minimum": 227.71, "maximum": 5611.0, "discounted_cash": 5513.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3035.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 5611.0, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 227.71, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, 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{"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 1562.5, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 28MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278016705", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 4418.75, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 28MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278022821", "type": "CDM"}, {"code": "278", "type": "RC"}], 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2706.26, "maximum": 2706.26, "gross_charge": 2500.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 36X6X1.5 REVERSED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278014378", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 1850.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 36X9 RETENTIVE REVRS", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278027706", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 3357.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 45% REVERSED -2M VE", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278039970", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 5750.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT 55% REVERSED", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278038585", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 5750.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ABDOMEN-VENOUS DRAIN", "code_information": [{"code": "49425", "type": "CPT"}], "standard_charges": [{"minimum": 590.47, "maximum": 4294.0, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3035.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 4294.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 3194.9, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 590.47, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 786.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "INSERT ACETABULAR 0 DEGREE 40M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278039527", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 1562.5, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT AND REMOVE BONE PIN", "code_information": [{"code": "20650", "type": "CPT"}], "standard_charges": [{"minimum": 104.62, "maximum": 5611.0, "discounted_cash": 5713.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3502.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 5611.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4886.31, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 104.62, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4137.23, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4246.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ANT DRAINAGE DEVICE", "code_information": [{"code": "66183", "type": "CPT"}], "standard_charges": [{"minimum": 2054.0, "maximum": 6602.0, "discounted_cash": 7218.14, "estimated_discounted_cash": 4281.33, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3502.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 6602.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4275.52, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 5196.84, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 3873.9, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", 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3-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278033811", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 2500.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ART CONSTRAINED S 5-6 R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278036770", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 2500.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR 11MM SZ 3-4 R", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278037376", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 2500.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR LEFT SIZE 3-4", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278036796", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 2500.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR SIZE 3-4 13MM", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278039940", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 2375.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR SIZE 5-6 15M", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278031726", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 2000.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR SIZE 5-6 RT", "code_information": [{"code": "C1776", "type": "HCPCS"}, {"code": "278036769", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 2706.26, "maximum": 2706.26, "gross_charge": 2500.0, "estimated_discounted_cash": 7424.11, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2706.26, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ARTICULAR SIZE 7-8 15MM", "code_information": [{"code": "C1713", "type": "HCPCS"}, {"code": "278037942", "type": "CDM"}, {"code": "278", "type": "RC"}], "standard_charges": [{"minimum": 520.45, "maximum": 520.45, "gross_charge": 2500.0, "estimated_discounted_cash": 3582.22, "setting": "both", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 520.45, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "INSERT ATTUNE CRS SZ 7 14MM", 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"outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 14.88, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 2.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVEEN/SHUNT PATENCY EXAM", "code_information": [{"code": "78291", "type": "CPT"}], "standard_charges": [{"minimum": 141.11, "maximum": 541.09, "discounted_cash": 698.12, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 228.82, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 141.11, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 527.17, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 541.09, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVETIRACETAM INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1953", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.52, "maximum": 4.52, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.52, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVONORGESTREL IMPLANT SYS", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J7306", "type": "HCPCS"}], "standard_charges": [{"minimum": 482.79, "maximum": 892.52, "setting": "outpatient", "payers_information": [{"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 892.52, "methodology": "fee schedule"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 482.79, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LEVORPHANOL TARTRATE INJ", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J1960", "type": "HCPCS"}], "standard_charges": [{"minimum": 15.68, "maximum": 15.68, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 15.68, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LICE TREATMENT, TOPICAL", "code_information": [{"code": "A9180", "type": "HCPCS"}], "standard_charges": [{"minimum": 24.16, "maximum": 24.16, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 24.16, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIDOCAINE INJECTION", "drug_information": {"unit": 1.0, "type": "EA"}, "code_information": [{"code": "J2001", "type": "HCPCS"}], "standard_charges": [{"minimum": 4.49, "maximum": 4.49, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 4.49, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 1ST STAGE", "code_information": [{"code": "S0340", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.18, "maximum": 14.18, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 2 OR 3 STAGE", "code_information": [{"code": "S0341", "type": "HCPCS"}], "standard_charges": [{"minimum": 14.18, "maximum": 14.18, "setting": "outpatient", "payers_information": [{"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 14.18, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "LIFESTYLE MOD 4TH STAGE", "code_information": [{"code": "S0342", "type": "HCPCS"}], 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{"description": "LIGATION OF A-V FISTULA", "code_information": [{"code": "37607", "type": "CPT"}], "standard_charges": [{"minimum": 272.52, "maximum": 5611.0, "discounted_cash": 5513.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3502.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 5611.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4886.31, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 272.52, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4074.15, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": 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"type": "RC"}], "standard_charges": [{"minimum": 142.73, "maximum": 146.5, "gross_charge": 241.2, "discounted_cash": 264.6, "setting": "both", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 142.73, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 146.5, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "MONONUCLEAR CELL ANTIGEN", "code_information": [{"code": "86356", "type": "CPT"}], "standard_charges": [{"minimum": 23.8, "maximum": 31.27, "discounted_cash": 48.62, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 31.27, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 23.8, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 27.4, "methodology": "fee 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"code_information": [{"code": "81402", "type": "CPT"}], "standard_charges": [{"minimum": 100.0, "maximum": 250.83, "discounted_cash": 272.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 150.33, "methodology": "fee schedule"}, {"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 250.83, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 153.79, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 157.85, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 150.33, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 4", "code_information": [{"code": "81403", "type": "CPT"}], "standard_charges": [{"minimum": 100.0, "maximum": 297.85, "discounted_cash": 336.27, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 100.0, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 185.2, "methodology": "fee schedule"}, {"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 297.85, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 189.46, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 194.46, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 185.2, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 5", "code_information": [{"code": "81404", "type": "CPT"}], "standard_charges": [{"minimum": 175.0, "maximum": 375.89, "discounted_cash": 499.01, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 175.0, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 274.83, "methodology": "fee schedule"}, {"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 375.89, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 281.15, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 288.57, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 274.83, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 6", "code_information": [{"code": "81405", "type": "CPT"}], "standard_charges": [{"minimum": 175.0, "maximum": 407.42, "discounted_cash": 547.16, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 175.0, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 301.35, "methodology": "fee schedule"}, {"payer_name": "Health Net", "plan_name": "Medicare Advantage HMO", "standard_charge_dollar": 407.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 308.28, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 316.42, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 301.35, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "MOPATH PROCEDURE LEVEL 7", 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117.17, "maximum": 117.17, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 117.17, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NF DSCHRG MGMT 30 MIN/LESS", "code_information": [{"code": "99315", "type": "CPT"}], "standard_charges": [{"minimum": 73.04, "maximum": 73.04, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 73.04, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGENT DETECTION GI", "code_information": [{"code": "87505", "type": "CPT"}], "standard_charges": [{"minimum": 114.04, "maximum": 144.9, "discounted_cash": 232.94, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 144.9, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 114.04, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 131.24, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 134.7, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 128.29, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS CMV", "code_information": [{"code": "87910", "type": "CPT"}], "standard_charges": [{"minimum": 23.38, "maximum": 293.72, "discounted_cash": 467.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 293.72, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 23.38, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 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"CPT"}], "standard_charges": [{"minimum": 228.84, "maximum": 300.69, "discounted_cash": 467.45, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 300.69, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 228.84, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 263.37, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 270.32, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 257.45, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT AGT GNTYP ALYS SARSCOV2", "code_information": [{"code": "87913", "type": "CPT"}], "standard_charges": [{"minimum": 0.01, "maximum": 270.32, "discounted_cash": 467.45, "setting": "outpatient", 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{"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 761.25, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 725.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "402U", "type": "CPT"}], "standard_charges": [{"minimum": 145.91, "maximum": 149.76, "discounted_cash": 258.97, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 145.91, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 149.76, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT AGT STI MULT AMP PRB TQ", "code_information": [{"code": "736T", "type": "CPT"}], "standard_charges": [{"minimum": 199.66, "maximum": 2363.0, "discounted_cash": 224.69, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 199.66, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 204.93, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "202U", "type": "CPT"}], "standard_charges": [{"minimum": 333.42, "maximum": 446.01, "discounted_cash": 756.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 446.01, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 333.42, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 426.37, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 437.62, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS 22 TRGT SARS-COV-2", "code_information": [{"code": "223U", "type": "CPT"}], "standard_charges": [{"minimum": 238.88, "maximum": 437.62, "discounted_cash": 756.75, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 416.78, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 238.88, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 426.37, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 437.62, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 416.78, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM NEG", "code_information": [{"code": "142U", "type": "CPT"}], "standard_charges": [{"minimum": 156.75, "maximum": 164.59, "discounted_cash": 284.61, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 160.36, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 156.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG GRAM POS", "code_information": [{"code": "141U", "type": "CPT"}], "standard_charges": [{"minimum": 156.75, "maximum": 164.59, "discounted_cash": 284.61, "setting": "outpatient", "payers_information": [{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 156.75, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 160.36, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 164.59, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 156.75, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BACT&FNG ORG ID 6+", "code_information": [{"code": "86U", "type": "CPT"}], "standard_charges": [{"minimum": 128.0, "maximum": 210.0, "discounted_cash": 363.14, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 128.0, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 204.6, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 210.0, "methodology": "fee schedule"}, {"payer_name": "Untied Healthcare", "plan_name": "Commercial", "standard_charge_dollar": 200.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT QUAN ANTMCRB SC", "code_information": [{"code": "311U", "type": "CPT"}], "standard_charges": [{"minimum": 8.27, "maximum": 8.48, "discounted_cash": 14.67, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 8.27, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 8.48, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BCT/VIRAL TRAIL IP10", "code_information": [{"code": "351U", "type": "CPT"}], "standard_charges": [{"minimum": 266.49, "maximum": 273.53, "discounted_cash": 472.99, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 266.49, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 273.53, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "NFCT DS BV RNA VAG FLU ALG", "code_information": [{"code": "81513", "type": "CPT"}], "standard_charges": [{"minimum": 114.1, "maximum": 149.76, "discounted_cash": 258.97, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 118.38, "methodology": "fee schedule"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 114.1, "methodology": "fee schedule"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 145.91, "methodology": "fee schedule"}, {"payer_name": 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"Commercial", "standard_charge_dollar": 6042.11, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 482.13, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 7485.19, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 7682.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN REDUC COMPD ALVEOLUS FX", "code_information": [{"code": "D7770", "type": "HCPCS"}], "standard_charges": [{"minimum": 7485.19, "maximum": 7682.75, "discounted_cash": 10337.72, "setting": "outpatient", "payers_information": [{"payer_name": "Humana", "plan_name": 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"standard_charge_dollar": 5235.92, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 7209.37, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN TX COMPL FRONT SINUS FX", "code_information": [{"code": "21344", "type": "CPT"}], "standard_charges": [{"minimum": 713.33, "maximum": 6602.0, "discounted_cash": 10337.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 5084.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 6602.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4275.52, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 713.33, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", 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"billing_class": "facility"}]}, {"description": "OPEN TX SEPTAL FX W/WO STABJ", "code_information": [{"code": "21336", "type": "CPT"}], "standard_charges": [{"minimum": 237.53, "maximum": 7430.0, "discounted_cash": 5713.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4534.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 7430.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 6042.11, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 237.53, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4137.23, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4246.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX LUNG INFILTR", "code_information": [{"code": "32096", "type": "CPT"}], "standard_charges": [{"minimum": 666.5, "maximum": 8997.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 8997.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 7893.27, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 666.5, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3806.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "OPEN WEDGE/BX 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6042.11, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 1834.32, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3806.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE BLADDER/REVISE TRACT", "code_information": [{"code": "51580", "type": "CPT"}], "standard_charges": [{"minimum": 1433.73, "maximum": 8749.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 8749.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4886.31, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 1433.73, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3806.0, "methodology": "case rate"}], 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{"description": "REMOVE CADAVER DONOR KIDNEY", "code_information": [{"code": "50300", "type": "CPT"}], "standard_charges": [{"minimum": 1903.03, "maximum": 5611.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 5611.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 3194.9, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "TriWest", "plan_name": "Medicare", "standard_charge_dollar": 1903.03, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CAROTID BODY LESION", "code_information": [{"code": "60600", "type": "CPT"}], "standard_charges": [{"minimum": 716.68, "maximum": 7430.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", 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{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 446.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4585.6, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 3418.26, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4706.63, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE CERCLAGE SUTURE", "code_information": [{"code": "59871", "type": "CPT"}], "standard_charges": [{"minimum": 134.78, "maximum": 6869.02, "discounted_cash": 5652.95, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 5084.0, "methodology": "case rate"}, {"payer_name": 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{"description": "REMOVE INNER EAR", "code_information": [{"code": "69905", "type": "CPT"}], "standard_charges": [{"minimum": 769.92, "maximum": 9537.7, "discounted_cash": 10337.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 6251.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 8749.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 9537.7, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 769.92, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 7485.19, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 7682.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR & MASTOID", "code_information": [{"code": "69910", "type": "CPT"}], "standard_charges": [{"minimum": 778.48, "maximum": 9537.7, "discounted_cash": 10337.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 6251.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 8749.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 9537.7, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 778.48, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 7485.19, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 7682.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INNER EAR LESION", "code_information": [{"code": "69970", "type": "CPT"}], "standard_charges": [{"minimum": 1767.68, "maximum": 9537.7, "discounted_cash": 10337.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4534.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 8749.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 9537.7, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 1767.68, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 7485.19, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 7682.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INT/EXT HEM 1 GROUP", "code_information": [{"code": "46255", "type": "CPT"}], "standard_charges": [{"minimum": 295.23, "maximum": 5611.0, "discounted_cash": 4847.11, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3502.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 5611.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4886.31, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 295.23, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3588.84, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 2675.24, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3683.56, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTESTINAL ALLOGRAFT", "code_information": [{"code": "44137", "type": "CPT"}], "standard_charges": [{"minimum": 3806.0, "maximum": 7430.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 7430.0, "methodology": "case rate"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3806.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRA-AORTIC BALLOON", "code_information": [{"code": "33974", "type": "CPT"}], "standard_charges": [{"minimum": 535.37, "maximum": 5611.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 5611.0, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 535.37, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3806.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRACORPOREAL DEVICE", "code_information": [{"code": "33980", "type": "CPT"}], "standard_charges": [{"minimum": 1039.46, "maximum": 7430.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 7430.0, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 1039.46, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRAUTERINE DEVICE", "code_information": [{"code": "58301", "type": "CPT"}], "standard_charges": [{"minimum": 48.64, "maximum": 2807.0, "discounted_cash": 532.15, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 2363.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 2807.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 986.66, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 48.64, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 410.04, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 305.66, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 420.86, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE INTRVAS FOREIGN BODY", "code_information": [{"code": "37197", "type": "CPT"}], "standard_charges": [{"minimum": 253.54, "maximum": 5611.0, "discounted_cash": 5513.87, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3502.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 5611.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4275.52, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 253.54, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4074.15, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 3037.01, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4181.68, "methodology": "fee 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"Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 3873.9, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 5334.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE JAW JOINT CARTILAGE", "code_information": [{"code": "21060", "type": "CPT"}], "standard_charges": [{"minimum": 670.14, "maximum": 7682.75, "discounted_cash": 10337.72, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3035.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 4294.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4275.52, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 670.14, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 7485.19, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 5579.71, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 7682.75, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY LIVING DONOR", "code_information": [{"code": "50320", "type": "CPT"}], "standard_charges": [{"minimum": 1011.91, "maximum": 7430.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 7430.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 3194.9, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 1011.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3806.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KIDNEY OPEN", "code_information": [{"code": "50220", "type": "CPT"}], "standard_charges": [{"minimum": 835.07, "maximum": 8255.0, "setting": "outpatient", "payers_information": [{"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 8255.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 3194.9, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 835.07, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 3806.0, "methodology": "case rate"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE CYST", "code_information": [{"code": "27347", "type": "CPT"}], "standard_charges": [{"minimum": 274.76, "maximum": 6602.0, "discounted_cash": 5713.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4534.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 6602.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 6042.11, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 274.76, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4137.23, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4246.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27334", "type": "CPT"}], "standard_charges": [{"minimum": 632.91, "maximum": 6602.0, "discounted_cash": 5713.85, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4534.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 6602.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 6042.11, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 632.91, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 4137.23, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 3084.03, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 4246.42, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE KNEE JOINT LINING", "code_information": [{"code": "27335", "type": "CPT"}], "standard_charges": [{"minimum": 645.94, "maximum": 9385.46, "discounted_cash": 12671.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 4534.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": "Commercial", "standard_charge_dollar": 6602.0, "methodology": "case rate"}, {"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 6042.11, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 645.94, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 9144.12, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 6816.33, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 9385.46, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE LAMINA/FACETS LUMBAR", "code_information": [{"code": "63012", "type": "CPT"}], "standard_charges": [{"minimum": 1042.44, "maximum": 9537.7, "discounted_cash": 12671.44, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 5084.0, "methodology": "case rate"}, {"payer_name": "Anthem", "plan_name": 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{"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 427.08, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 1329.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 3631.92, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 2707.35, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 3727.77, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE PILONIDAL CYST EXTEN", "code_information": [{"code": "11771", "type": "CPT"}], "standard_charges": [{"minimum": 295.23, "maximum": 5611.0, "discounted_cash": 5072.47, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": "Commercial", "standard_charge_dollar": 3502.0, "methodology": "case rate"}, {"payer_name": 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{"payer_name": "Blue Shield of CA", "plan_name": "Commercial", "standard_charge_dollar": 4886.31, "methodology": "case rate"}, {"payer_name": "CalViva", "plan_name": "Medi-Cal", "standard_charge_dollar": 253.16, "methodology": "fee schedule"}, {"payer_name": "Cigna", "plan_name": "Commercial", "standard_charge_dollar": 2054.0, "methodology": "case rate"}, {"payer_name": "Humana", "plan_name": "Medicare", "standard_charge_dollar": 2467.86, "methodology": "fee schedule"}, {"payer_name": "Meritage Medical Network", "plan_name": "HMO", "standard_charge_dollar": 1839.63, "methodology": "fee schedule"}, {"payer_name": "Sequoia Pace", "plan_name": "HMO", "standard_charge_dollar": 2533.0, "methodology": "fee schedule"}], "billing_class": "facility"}]}, {"description": "REMOVE SPERM DUCT POUCH", "code_information": [{"code": "55650", "type": "CPT"}], "standard_charges": [{"minimum": 357.64, "maximum": 3194.9, "setting": "outpatient", "payers_information": [{"payer_name": "Aetna", "plan_name": 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